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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: PROPERTY TAX# PERMIT# <br /> Rod %dtc -' 5rrrt'` E2/&,-e# 4ili4 9& ( .517GO, 1 546 (7 1'2117.2 -v-7-4 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Gid&,-C%/ G'�h'I,Y1 tin f� L+/�i7' Phone/E-mail 47 67 . .901(0 P_i5n 1'05 <br /> Address 7--; f y p ,6i/{-✓C 61 G�� y8 aol <br /> p�(Xy� (,tJL/ tYit Cit /State.Zi <br /> APPLICANT: Owner _Owner's Agent x Contractor_ _Contractor's Agent Tenant(most provide a letter yr consent from the owner to do work in the space) <br /> CONTRACTOR frim'/ /- <br /> 4- o/2,571e-l/G77L&I Lic.# <br /> 1�r00Io0NLl`�Lv COE Bus. Lifer-740Z <br /> /1"1,17` ra/ ` / <br /> Address /'6/ /.1,442„,4 4 04/40 J/fCjT'l/c) 4,(/A- 99j/3N Phone/Email epirilp. C�.4 7�f 04 iegie/}fa�.Cio✓n <br /> TENANT BUSINESS NAME CONTACT FOR <br /> PERMIT <br /> tel <br /> � 7�+'/� A -1, . - 'fit-"�! Al/ �S <br /> � ���'k .(i✓ (-rp-e--t Phone/E-mail gQ/J. p7.7777 ieerl M51crj !r;CZM <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /50,,poO .o0 <br /> Existing Use of Building OP HEAT SOURCE: <br /> Proposed Use of Building 444- Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse Multi-Family / Commercial <br /> Type of project: New —Addition Remodel ✓ Repair T T.I._Sign Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORKadditional space f'f°vided on the b ck : <br /> &'t' -t, ' t�7m%11 yyl 1 +ti ' //eP�e5/vj Lz1 Er;dy,..e. Gln jf-/. c1,4" i-/ arcs, <br /> f?dir.5' .c'!9 eX T/T/�q S-717"1/624izeS . J <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 /> NC—air handling units I Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I Shower <br /> I Gas fireplace I Kitchen sink&disposal <br /> I Gas range I Dishwasher <br /> Clothes dryer i Clothes washer <br /> Range hood —I Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodstove I Grease trap <br /> I Ducting I Roof drains <br /> I Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I 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. : - - roperty 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 /> _____:___. to <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) 1 <br /> /Z <br />