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r • <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 ADDR S PROPERTY TAX# PE MIT# <br /> --11`.-.7 i `;_., t,V ) icl-- Cle-,Z 60e i t\I 3 01-do (-- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER C, .� £ F -IEC ii Phone/E-mail <br /> Address 157.-ZS 7 71`j j '{o 1* ( ' C �ity/State/Zip L-.VT {,V4162c <br /> I ________ <br /> APPLICANT: Owner Owner's Agent K Contractor Contractor's Agent A,TenAant(must provide a letter of-consent from the owner to do work in the space) <br /> CONTRACTOR 1� F & f" C T 1C>h.> L&I Lic.# /'TJ�V rfri i'G� COE Bus. Lic.#02410. <br /> Address 'O e{'X 1541. Di r...)VtLL T3C-'1Z Phone/Email 4L_G'4e.. ----- ,...c.;7 <br /> TENANT BUSINESS NAME / CONTACT FOR PERMIT -;', F ���I- <br /> CCA-CAl FJFptt Phone/E-mail Zo ' IG-C� "``re � fC1.J <br /> BUILDING PERMIT APPLICATION .CONTRACT PRICE OF WORK M11 71® <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 /> DESC IPTION OF WORK(additional space provided on the back): <br /> 'b pt k)I L)U'i�t'. HE-2z L it.)E.-• it-) M I/61-M :c- .tet--t <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 /> Si 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 /> Tha 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 /> .4._ <br /> Owner/Auth ized Agent Signature Date (Revised 6/2012) 1 <br /> .) <br /> 1 <br /> 1 <br />