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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: j n� /)�� PROPERTY TAX# eEJ,2M11#� _� <br /> d-b /Lti 1Y� Y <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNEROWNER MooJ._jN�,l�A,S rS Phone/E-mail d_lt^-, --,-� C e-,/,.s- cr <br /> Address � --L7 l Ci(\ ( /,O €.i1 W/I !'U c _C) <br /> APPLICANT:_OwnerJ _Owner's/leak <br /> Agent Contractor _Contractor's Agent _/' Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Cozy H J-fti £ /�/ ! /1 L&I Lic.# (.k?Zy til* 1)-().#1//1 COE Bus.Lic.# 0 A y6%1 <br /> Address a-©)—`d—I J 6.7 l' Ave !V[ Ari /t cal k 1i14 Phone/Email 3 © r'y 3 3-- y P® / <br /> TENT BUSINESS NAMECONTACT FOR PER IT <br /> wOD8-vh.c .fe-� Phone/E-mail Kd e 6,,62)(41- 360-y3ctir04// <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 7-000 . 00 <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_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTIN F WORK(additional space provided on the back): <br /> s aI�(� G A 67,16 k ? c/c . e S I{ec�t 0 ,,,--,p <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 /> 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 /> Ducting p Roof drains <br /> I Other buC.-le�5 �a,iL TLk wtp 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 thi property to perform the work for <br /> �which application7is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (9c;:6, <br /> OvQ er/Authorized Agent Signature Date (Revised 6/2012) <br />