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,% � nn I � 1�(1- a i cv_i_i J, (,-5 .00(3 <br /> �� PERMIT APPLICATION <br /> \ UIL $G1MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CCITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett. WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRFSS• PROPERTY TAX# PERMIT# <br /> 6O L, 7t1, 4 vc S Z4i50s(g i)0 30 1-/o tv 5 130 V - Oda <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER r64S4.1/a �1�g1.1w'14r`r reL Phone/E-mail <br /> kir, -. SO(, ` T" A- _,1,_ <br /> �S t- City/State/Zip Ev :rT ktA <br /> APPLICANT:__Owner Owner'sAgent (/Zontractor -Contractors Agent _Tenant(m ~arta <br /> CONTRACTOR (--16t V-1 +L S('1In s L& I Lie.it er:AR(SM34 COE Bus. Lic.it <br /> Address -7204 AtE (i V�' ' f )Orre wA t )2 Phone/Email 4.2_„S" l it i- 9 (2 00 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> EaSf(A COmel, ur-. r 01.4.4 VC—I—. DCStn.Ka C9-r-e,eh <br /> Phone/E-mail (/-ZC Lf-$$ 7 <br /> ,`(pr�00 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 ooa <br /> Existing Use of Building _ -w-J Z(..- . . _ HEAT SOURCE: <br /> Proposed Use of Building C-t+tr 25.=1 _ Gas Electric_ Other_ <br /> Building type: _Single Family Duplex Townhouse _Multi-Family Commercial <br /> Type of project: New __Addition _Remodel Repair__T.I. ,Sign__Sprinkler__Demolition_Change of Use <br /> D —IPIION OF WORK(additional space provided on the back): <br /> elip (h s fia f I one set Of h 0 r-. - /nu vx-, r'r,a 7-cd /el'T4--S Oh Wet( <br /> A c 'GK/'S1-1'- kin oh u v), ehcF S 15 I, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: __New_Addn _Alteration_Repair Type of Project: __New_Addn _Alteration__Repair <br /> Show Number(if)of fixtures Show Number(S)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other_ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.Al provisions of laws and ordinances governing this type of work will be complied <br /> wth whether specified herein or not.The granting of a permt does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am a horized by the owner is property to perform the work for which appication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 64- Cd. 14, t3 <br /> OwnerlAuthorized Agent Signature Date (Revised 6/2012) <br /> 9Z <br />