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• <br /> 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: �7 j/ i� � c fi Eve�rr 06547 10 z11 o,` PE IT <br /> I 1 �" yip Y� r 73�0(X?11 V(� <br /> LEGAL for new construction: Short Plat/subdivision 1 Y N fiat[Lt a/Z i T:tStLot No.-,S , (attach copy of long legal description) <br /> OWNER,Scc PCC. FOtnr S Phone/E-mail Li q _3- Z400 <br /> Address 9 D Sic) (V r eft mai Iai.l a, loth. 1.'City/Stateizip f vl l_ tea WW1 <br /> 1 <br /> APPLICANT:_Owner _Owner's Agent _Contractor /1 e6ntractor's Agent _Tenant(must provide a letter of consent from the owner to dowork In the space) <br /> CONTRACTOR Ad WGnf t' / ml.�l' r LLC L&I Lic.#/1vvfln PL91?Lc COE Bus.Lic.# o j2Rie <br /> Address I A 6'C u r ,� #') .J Sho loon vi Phone/Email f2. - 3k1�. c/pU <br /> TENANT BUSINESS NAME / CONTACT FOR PERMIT <br /> —TC Wilt,}c C-it fir, <br /> i � n3�0 °102- 3rrvJ / ��j <br /> Phone/E-mail ✓ -W✓1 4 vr("(.(C (ia`Ia O/thi hhrn - /Ma <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WSRK J <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 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): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 4eNewAddn Alteration Repair Type of Project: _New_Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)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 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 /> , C) 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.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 <br /> That I am authorized by the owner of this property 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 /> kt.k/� cI . r v//�d/s" <br /> 112_ <br /> Owner/Authorized t SI natureDate <br /> g (Revised 6/2012) <br /> J <br />