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SERMIT APPLICATI09 <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# PERMIT# <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> OWNER L I b.'?t�� fZe5 i" -S L-,L-L Phone/E-mail <br /> Address P-o. k)D>- >Z b 7 City/State/Zip C w & <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 I���► L&I Lic.# �V 12 L'(1�L S�r`Z COE Bus. Lic.# U'' J 5.5 b <br /> Address 12;7 Sr,> ,� �n 7r. � i/1 Y �// �l U,6' Phone/Email — 6 -� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Awkl <br /> Phone/E-mail gv{."Zq7 6t LtA L -c Wwr <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK V1 s q Z 7.OL' <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 V T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DYESCRIPTION OF WORK(additional ,pace provided on the back): <br /> ) n <br /> cX,11t� Vt1U✓v� �'l��� t4-�"`f" t�v✓LS I ^Svt;W`L'v <br /> JV4-,, V,- ( gr C1 fRll"rA i -ri C s� lz;-� f P-4-S . <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 /> t1 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 /> I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM F- 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/Authorized Agent Signature Date (Revised 6/2012) <br />