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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY 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 ADDRESS: F6D,5 h Ave_ L.), PROPERTY TAX ft 1 o2- oe2 . <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> // t <br /> OWNER <br /> `�1'IsJ�-IQfn N ✓tr7r Phone/E-mail <br /> SZ i �4;�� AugAddress !1'x°'1 'i{l4tr.), vol ct ivere-Hi1/41,..CitylSlate/Zip <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR H o r- rc L&I Lic.# COE Bus.Lic.# <br /> Address 1000 it e ij + cry ri >•ZigIf \P Phone/Email (4/ZS)lo5(d-0500 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ;'.req CA"4- v+d (4Z9 3C -14-F..S <br /> Phone/ff-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /2- r, •, �— <br /> 'Y' '' $ <br /> Existing Use of Building IM , 4-7 - ok 1 I HEAT SOURCE: <br /> Proposed Use of Building $CLP1 t e 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 /> DESCRIPTION OF WORK(additional space provided on the back): p_., 7i�� in j')' •--.� ' C_ <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(#)of fixtures Show Number(#)of fixtures <br /> A/C–air handling units .Q 1 Toilet <br /> Forced air systems Bathtub <br /> 1 Gas piping ( Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I j Dishwasher <br /> Clothes dryer washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater 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 <br /> Other: <br /> Number of Heads j Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction i <br /> That I am thorized by e owner• this pro.- to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 77, <br /> 3 <br /> Owner/Authorized Agent Signature g g Date (Revised 6/2012) <br />