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0 • <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: PROPERTY TAX# PERMIT# <br /> 'ii-ii , -77d,-C- /r Z tv , j) .c- 7c9 1 d c5Yo NM 12-0 62 — 640 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) 69-A__/)4/4 <br /> OWNER Zeal ieLly tyt 'L�`�Zy,i/�zPhone/E-mail <br /> Address J City/State/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 f%8. LL L . t re, I Z L& I Lic.# NIE W C E(C ?CIS N COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME _} CONTACT FOR PERMIT Dajv td z_e_e_ 6.4/7_6ev1f1 <br /> K( NOO d.I RC17 ai I Phone/E-mail v‘Gt6.00J�/094 G r-on <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1f000 <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 /> _A/s,74.41 -0 / 7Y8" '' ' <br /> -1/40 S% 1.d-2 c'vJ " ,-47%.11j vj T �2.V 4 U' ./6 CJ /�� <br /> c ,t Fez. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New X 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 i Toilet <br /> Forced air systems _ ; Bathtub <br /> Gas piping I Lavatory (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer j Clothes washer <br /> \% ! Range hood 1 jp e. E I Water heater <br /> 17 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> I 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 <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 /> -------1". 2.--77: —.' ' ' 6/21'e'Z.2-C2)7 2_ . <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />