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IF , . Ill IP <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 /> a- P----7. 73o\ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# P RMIT# <br /> - j-t-� \,72.4.-----0 �, <br /> . m U,.)-".1 ✓r A 70» 5'c Q co 1; ( 1 -t � F; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNERgllcL)J4 - vtc\ S i_LL Phone/E mail :t.►.�rc� . h°�\o(4��\ f' .Cir"i\ /_ — <br /> Address 5 ,[D �GC rl�1L: <br /> �) \ City/State/Zip Ix ti�L1 CNA S C( 9)3rIX.. .' <br /> APPLICANT:_Owner _Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a latter of consent from the owner to do work in the space) <br /> CONTRACTOR r�7 Q cis e*1 ✓C ,,.� L&I Lic.# c�K) VC.l(L1�U� COE Bus. Lic.# <br /> Slt�— S`� lu <br /> Address L. n C\ ;�V \U1� `jS _ 7 Phone/Email cL ;afy y (�tl� J.,1i G, .1:7,L <br /> TENANT BUSINESS NAME I I CONTACT FOR PERMIT 1.4..e_\\LA (In C)(\ -t (O <br /> E, i w C v,i2.t1! 1-:2)' A�e L<_:.,.,i ; 1.0,,,, k A Q- 10g.-&©7-)i-73_5 <br /> Phone/E-mail ; l(, c j'\n CiTh±( i C CIM .`vt.-Lr..4.,.f; 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK c) C? O `I= <br /> Existing Use of Building `) �,1 "--- •„ HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building type: Single Family Duplex Townhouse Multi-Family t Commercial <br /> Type of project: New Addition _Remodel _Repair T.I. Sign Sprinkler /� Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Oe•---A0°\ CD 'BO \ \CA\ t`/\_' ( <br /> .-----L4-4— (3.3` -Cr;5 <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 /> 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 parent 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 /> r\I\ '6/(VIelt-nr-1) )( <br /> Owner/Authorized ent Signature l3 (Revised 6/2012) <br />