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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# PEBMIT# <br /> ZS 00 7-l /11/e— I I M I L4 0 2--0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER .SNpti 0,,1 4 C�.,NT lElf/ Phone/C-fmeil 1/7-5- 7 33 - YY5Z <br /> Address i1 L' 75y�< f/ St City/State/Zip f7Vt1 &T'7 4,q (- JJ L,['/ <br /> APPLICANT: Owner Owner's Agent Contractor Contractors Agent /_Tenannt(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR R6%f V-/L4 70 C ��7�'D d// h S COE Bus. Lic./#� ©S Z 1 <br /> Address &oz A,1 9*5 � '*117 1 ,r,1?7^'4 - 4A /c,000 Phone/Email �p$�F(r�P ti•2 /(�/-A�t.C1h <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> p was- <br /> T / Ll 0 Phone/E-mail Zr3 " Z79 " ?-ZO <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ 11, cj5J,vL' <br /> Existing Use of Building 0 HEAT SOURCE: <br /> Proposed Use of Building ( Gas_ Electric Other <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family -?OCommercial <br /> Type of project: New Addition _Remodel _Repair_K T.I. Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): 1M <br /> ..5'"t/ / V,ic7 /e-;f S,06r syr'T 1104 .p Z k}c�4w57 w ^! A <br /> 3 -rAANs F"-lz gA,'i/fr -- 914 04 r-PeV 5 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 1C.'New_Addn )tWteration_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 /> f 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 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 /> Owner/Author' a gent Signatur Date (Revised 6/2012) <br />