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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: PROPERTY TAX# PERMIT# <br /> ,opo frerf eye,-€# u', 98aar 6%f,/7 O aU/5O6 11)(L <br /> LEGAL for new construction: Short <br /> Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> OWNER .#/�/nan f //.e re_, Phone/E-mail 4/,,,V5. n$3 .90aCv p /5/7aa'©5(v� <br /> Y p �v�.-' ref u/i 9,ej a' <br /> Address O, ,e;456770 WC" � <br /> � 7'.�r� City/State/Zip � <br /> APPLICANT:_Owner Owner's Agent x Contractor _Contractors Agent Tenant(must provide a letter of consent horn the owner to de work in the space) <br /> CONTRACTOR/ ,/? 7a- ��t jty'f/ . 4 1 L&I Lic.#/pgO/ /'�q(p COE Bus.Lice#( ,(j <br /> /ylp/i`��irdl L // ,1 p` ,y/ �j <br /> Address/Q/�y /Sr Ave., S i1` y� Jp4//e 14),4 !g/ Phone/Email a66p. a97 //,4ie.g4 j144!..&../n <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �l� �/.4.'i'4� �y��'"rY1t,.��-�r7i���/yl�/�j�-�:Gor!'J <br /> / /Vl t uYi�y � Phone/E-mail rp(0•CYO�`7•t�// i 1erry, / <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Ai /50/ '4)(0 •4":' <br /> Existing Use of Building , /,q HEAT SOURCE: M. <br /> Proposed Use of Building ii/A' 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 /> DESCRIPTION OF WORK(additional space pcovided on theb ck): <br /> �'vU-ei U7 4c.7/ of� // p /e /ypz.el Eric*, segeld � Qdbe G;, rS. <br /> 62/1 Erfkk*/19 Sie/uc 7ireS <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 /> I 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 /> 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 authorize. • r .• . : is 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 /> v - �11��1015 <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />