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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# PFMIT,# <br /> 5728 12th AVE W# A 00868101100100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Sandy Ceronski Phone/E-mail 253-217-9097 <br /> Address 5728 12th AVE W City/State/Zip Everett, Wa 98208 <br /> APPLICANT: Owner Owner's Agent X Contractor Contractor's Agent Tenant(must provide a letter or consent from the owner to do work In the space) <br /> CONTRACTOR Bobs Heating and A/C L&I Lic.# BOBSHHA853NC) COE Bus. Lic.# 41388 <br /> Address 14148 NE 190th ST Woodinville wa 98072 Phone/Email 800-840-3346 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT James Gosnell <br /> Phone/E-mail 206-378-6723 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2800.00 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: X Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project New Addition _K Remodel Repair T.I. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK��(a//d��dit(additional space provided on the back): <br /> �L'�-l.L 1 l[v I,CL---' <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 /> 1 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 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 a 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 /> Owner/Authorized Agent Sigr e Date (Revised 6/2012) <br /> C <br />