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• I <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:4909- _SApeh j �,ft (PROPERTY TAX# PERMIT# Y <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> OWNER%"04/408,444h4 4,4I1/G4=0 '••g 6"1 4'644, Phone/E-mail // <br /> Address dolt) 164 n` r vE 8f(7" su k►W' City/State/Zip 13e 1 Cj to-1-i4 /'7 <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 t°Ku-If A_ qL <br /> p& ' <br /> I Lic.#t1�L te�L1Z COE Bus.Lic.# <br /> Address TV b �3' S1- 4942C� l�,r�/4cSwri V/4" /f/�,°/ Phone/Email )04-2-CC "2'() <br /> TENANT BUSINESS NAME CONTACT FOR <br /> PERMIT a.00.LS5-ep�j2� <br /> g f.�tGSA ��'✓f"�/ Phone/E-mail )0,4..06"T�L <br /> M'lWt <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 51iet) <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 t e back): ..17444.0 L " xt GKa— eD44... <br /> �w'9 GL ‘0,-^"i u -rro 6( M Gc, sc 1[y C–rr,M G••G� �t,— /�-cwc to �p., 5re—c <br /> YR Mwt <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 /> 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 /> Number of Heads Other: <br /> I hereby certify that I have r.a. <examined this a•-'ion 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 specifi-- or not.The gran' ,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-uth• . • 'e own- . this•Arty 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 /> l -.9071 <br /> r n uthorized Agent Signature Date (Revised 6/2012) <br />