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• • <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: f��//f PROPERTY TAX# PE MIT r <br /> C=am 0 S 41-;0 1- 1 6cc.l cf- \C2 v� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �j pis�L�J — Phone/E-mail <br /> Address t-` (LA.Z t:IC r�j KLv City/State/Zip �V;kti T l vtl <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 -IL 1, 0T U rJ�- L&I Lic.#�'�S�L 5 L`:t MA lSK COE Bus. Lic.# 0520't <br /> Address Z 10 G-, 1 V rt' rj—, )rAJ.0 N u c?y —1'�)u>6 Phone/Email - L s e t, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> S� �Av I!N <br /> Phone/E-mail `—I'•f4•Z'S,00jt- lc,�4�O 1,41 W � kJ i4.- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � `L,1',nOO <br /> Existing Use of Building L A-fz v,� c,04 I HEAT SOURCE: <br /> Proposed Use of Building L n�U t -k T v!f L Gas_ Electric ? Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family __k Commercial <br /> Type of project: New Addition Remodel Repair_T.1._Sign_Sprinkler_Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> s C>> �2ot�cSS <br /> G-° <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New 7�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 /> i Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater i Shower <br /> Gas fireplace I 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 /> Z Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove ; Grease trap <br /> Ducting Roof drains <br /> Other C.-N r L'✓_ ✓ 2�,c a-ss 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 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 /> wner/ oriz Ont Signature Date (Revised 6/2012) <br />