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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: IPROPERTY TAX# I PRu1 # r , <br /> � I <br /> ZF tiitrJt A✓� ' Q <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER (i REGI&/" f l`LpeLr IIES Phone/E-mail <br /> Address 372 i pbwe Ave City/State/Zip Evcr�ft-,/,m �t'��, i <br /> APPLICANT: Owner _Owner's Agent Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR <br /> n 8F) �,s,L,/��.,� 1 r� /� L&I Lic.# p�1 COE Bus.s.Lic.# /y <br /> Address p[J Roy f«0 C7.RL1,tise yolk IJ/ 1 5L Phone/Email yz5-3g -©Izl ha) low DROL..cc," <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ?,e4) fid <br /> G'o4 YQf51--C15 Phone/E-mail /25-.3gg`L72z-1r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK qIC'L <br /> Existing Use of Building itAtilkeuie. HEAT SOURCE: <br /> Proposed Use of Building wait}Iota J Gas Electric Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family !� Commercial <br /> Type of project: _New Addition Remodel Repair X T.I._Sign X Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additions(s ace provided on the back): 'D � <br /> F>a 1.ct 44 t. t9cam--U <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 Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 13 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 />