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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: AA� !A r�_, � <br />'Tv <br />PROPERTY TAX # <br />P MIT # <br />31qog-o <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />OWNER C- 11-cY 017 �1/ep-eTT <br />Phone/E-mail '1 �Z �g f t (Yl$OVl �1ICIf'� W <br />Address wsw c woM-KS <br />1 <br />City/State/Zip L-/a- n11i�i pQmpSep <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 6Govn t4W[� <br />L) & I Lic. # COE Bus. Lic. # <br />(Gvl �,� <br />Address JYlo`'�.�i'L'w�`' <br />Phone/Email <br />TENANT BUSINESS NAME N/ ^K <br />CONTACT FOR PERMIT /M(KE HLag- <br />Phone/E-mail -+X'7-*-85o0 MN &I1N <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK ,S qD, OOQD. Ole <br />Existing Use of Building PIWA C WAtMS &MMCMAJ11IJeeE <br />HEAT SOURCE: <br />Gas_ Electric_ Other_ <br />Proposed Use of Building Sllhtr <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi <br />-Family _ Commercial -�g P{rt&AL (ooA-KS <br />Type of project: _ New Addition _ Remodel Repair _ <br />T.I. _Sign _Sprinkler Demolition _Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />ST/4b f I -RE 7W0 e-X-rf--a-c &A- 6WJ C-uT <br />MA 1 N- LAM A NC S cot Z "Plo n uS <br />gCft AtZ' (ST/A4 SCA%- p-4►yq-WATSr i-- '�aN6 S �✓� ��w S 4E8 <br />nu ZM PtN Pt Les . <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration- 2epair <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />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 />ZdJ"4— / /ram <br />Owner/Authorized Agent Signature Date (Revised 612012) <br />0..5.V I <br />