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IERMIT APPLICATIOP <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# PER <br /> " ivesv04)6, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER /�k�f�J y / -(/- / Z Phone/E-mail <br /> Address s vt7 a 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 1L1e, fl i'e Cc's j c L& I Lic.# Le%cj YrG Z fe,C)LJ) COE Bus. Lic.#0L 6 <br /> n <br /> Address 20C' S'% S-• �c-v7' rii Z Phone/Email n <br /> TENANT BUSINESS NAME CONTACT FOR/PERMIT <br /> �/� .,✓ 1/rl' (�'c ,j/Ijc/ Phone/E-mail �C'ry.A.?AC—/ t- r c•.r77 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORIif e7 eV.0 <br /> Existing Use of Building %c' r e<.rz 42HEAT 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 _V Repair_T.I. _Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> p4F,, y/.J" y/�/ /�s+/es.�/ �J�C%/ 7�j/ t s".i�� lc-.r iip nJ s'►/r7�t'11 j rte/ Y t-e e/ <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 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 v,),zA-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 /> Y - <br /> Z-5� <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />