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PERMIT APPLICATION <br />tl . <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 It — 16 — if Z <br />�ITE ADDRESS: <br />,/,r-/ 11dr A-e 11t ��u <br />PROPERTY TAX # <br />P MIT# <br />z -�3 <br />LEGAL for new construchon Short Plat/subdivision Lot IJo. (attach copy of long legal description) <br />OWNER �l K ill <br />PhonelE-mail I `v lop U <br />Address <br />Gty/State/Zip <br />APPLICANT: Owner Ormei's Agent _-Contractor Contractor's Agent Tenanl(m�srpC.deeanerofconsert ton re e«ner ro aowoAm Me space) <br />CONTRACTOR <br />im a niIN <br />L 81 Lic. # COE Bus. Lic. # <br />Address r Phooe/Email <br />TENANT BUSINESS NAME <br />N1OTwm opus brelf Abru9hhf <br />CONTACT FOR PERMIT <br />42.1; ;0'4t)5;4 <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building wr Lr HEAT SOURCE: <br />Proposed Use Of Buildlnal r�r 11{ S� .i�C( 1 Gas__ Electric i Other__ <br />Building type: _Single Family — Duplex_Townhouse _Multi -Family Commercial <br />Type of project: _ New Addition Remodel Repair T.I. Sin Sprinkler!� Demolition Chan a of Use <br />DESCRIPTION OF WORK (additional spaceprovidedanthe back): At_I((i-f I0if D4�`Y\ljlI, in <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New y_Addn _ Alteration _Repair <br />Show Number (#,i o!'ixtures <br />Type of ProJecl: _New _Adtln _Alteration_Repair <br />Show Number (ql o! lixmres <br />A/C — at, handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas p.ping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />_ <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />I Water healer <br />_ <br />Exhaust fan <br />I Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />i <br />Boiler <br />Drinking Fountain <br />Refrigeration WALK (A (.Cc`LLk; <br />Floor drain <br />Woodstove <br />Grease trap <br />DuelingRoof <br />drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />j Number of Heads <br />Other: <br />I hcmby certify that I have read and Carl this application and know the same to be eme and Correct. All provisions of laws and oNmances govemitg this type of work will be complied <br />With whether specified herein or rill. the #ranting of a permit does not presume to give authority to violate or cancel the pmvislan of any other slate or local law regulating con stmclion <br />That I am autho;Iced by the owner of this property to perform the work for which apPkatan is made and I Comply With the Slate Contractors Lew 1e 27 RCW and 2% 200A WAC. <br />1 <br />jwker/Authotnd <br />Agent Signature Date <br />(Revised 6/2012) <br />