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6:Y° <br /> 2 PERMIT APPLICATION O128 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES /b-/4.1/ <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: PROPERTY TAX# P MIT#, <br /> //17c 4//2/-207. .ret.,-/A/ A/ A A1toi° 'T IL4L I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 'rr <br /> OWNER C/fF' el46(4„,, A,%t Phone/E-mail ?1 -J!r 9/Z9- 7 �y1+��7'!3L✓ e <br /> Address//6•1r „��,i/P/2 4gj City/State/zip 'e 4 <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) J <br /> CONTRACTOR -7/04.9 --, - je <br /> �/,?!j/ZX ���7//c L&I Lic.# 4DA-s�///JOjVj COE Bus. Lic.# eIZZ g'e'7 <br /> Address g/Q- /74.E„. rf 5 �� / FlA one/Email 266-e <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> SGn//2/fr c44/sAvvlend , C"-AivcS=. <br /> Phone/E-mail "/"C AC? ?J'?05/21-/ti ex-.cat,/ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 25 ie. <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family •X ommercial <br /> Type of project: New Addition Remodel Repair T.I.)ign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Ayr: v- moi CEJ / . /r��--�•.�►�-� r!/�ti lrGl <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 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 /> 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 wit be complied <br /> with whether specified herein or not.The•r,..• -._- •- .. .. .ot 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 theo • . .,is property to perform •• ,•ork for which application is ade and I c.mpl with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / <br /> Owner/Au _.razed • •• tSigna re pat (Revised 6/2012) <br />