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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: PROPERTY TAX# PERMIT# <br /> C 74t 7d'r.C" -�.� � r,� r�z�f� ie,-e-7 c�r° j1Zp ( <br /> • -O2g <br /> LEGAL for new construction: Short Plat/subdivis nqq Std.fib—ex Lot No. (attach copy of long legal description) <br /> OWNER �L'r �.i /' y L.E`LPhone/E-mail <br /> Address „I-27i (4-4. etLL�t�LG �r'ed City/State/Zip <br /> APPLICANT: Owner Owner's Agen _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> q� <br /> CONTRACTOR 7-• r� L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> t L 6-rn 7-6 CAP/ <br /> e`a`t• 41. Phone/E-mail �4,/rf (6`e,.• ,i-y 6) lc w/ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 30(0-07) <br /> Existing Use of Building Re. 1 \ HEAT SOURCE: <br /> Proposed Use of Building A -2-- 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 /> eco C/l f?, e./ <br /> /A6^ p CO3/, . <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 j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater j Urinal <br /> Boiler I 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 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 /> ((( <br /> 650677.2-0 r <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />