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r , <br /> PERMIT APPLICATION <br /> BUILDING/MEC HANICAL/PLUMBING/SIGN/SPRIN KLER/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# PER IT# <br /> I�`--Zv 41 1 '�" a;r�%Z&T- C 1'6 " L; 7 1 i ?16- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER L,)A1`t-S t 3c-; Phone/E-mail <br /> Address rcc i -a -A-S4Ani City/State/Zip }'C'h'i-i— -t t tile. �ifS 1 C'`+ <br /> APPLICANT:_Owner Owner's Agent `Acontractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 1—d-T- ti t c 0, n v,-) t>-ti7 5C-G2 aye-E=�, WC L& I Lic.# tz9 kt 0 c(--) }c-c,9`, C­� t-- COE Bus. Lic.#c3 S 15 2.. <br /> Address (:t c'c-- ` S CLQ mu-F ' ( j LG c -2(_•L�1 4 C= <br /> Zt ' J, `� ^ Phone/Email Scl ce, e• <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �� v rIFZ`5 <br /> Phone/E-mail 7'xE'7lb C�r!`fC' , ScbtnthlyL`��I�oc�c� ee� •� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4; 13 L: <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): A�cN ) AN t� (�[=IIv=;I-4-LA-71 to <br /> M'e,,-0 a` ef= Ft"_ � y-sTL,.h �,; „vt C- L � j 6 C-- ) <br /> fr.;'2 New trvv05 "7 C. wtAry v�Fi4c.}t�rZEL' ul. C C SPE�fr't��t Tl <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 airs stems 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 OPPRESSION SYSTEM Other: <br /> 2— 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 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 /> � t - _7 -711 <br /> OwneF/A thorized A ent Signature Date (Revised 6/2012) f <br /> 6 . <br />