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Fram: 0 06/2 /2013 10 :55 #381 P.001 /001 <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# PyllT# 1 <br /> Z27i� C� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:—owner _Owner's Agent _Contractor X—Contractor's Agent —Tenant(must provide a ever ofconsent from the owner to do work in the space) <br /> CONTRACTOR -`' ' �� j; L&I Lic.# L7;P �.` ' COE Bus. Lic.# <br /> Address�/Z� �1L,r vIV tN c Phone/Email 3' C-X-2� <br /> TENANT BUSINESS NAM CONTACT FOR PERMIT ,/� <br /> i YT Cil' <br /> >. Phone/E-mail —6 O. f <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORM <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse Multi-Family A Commercial <br /> Type of project: _New _Addition Remodel _Repair T.1. Sign_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Zn5; X11 (-z) k':4tvlcen KS " C L5 d,+5h�'-c6herS <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Adds Alteration_Repair Type of Project: _New_Addn Y 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 DrinkingFountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEMOther: <br /> Number of Heads Other: <br /> I hereby certify that I have read and e n 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. a gra ting 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 /> Thatauthorized by the owner of his pr erty 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 /> Ow nt Si Lure Date (Revised 612012) <br />