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I <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 /> I; 4-1 I I+D AvZ (44.0 0G-1-7 H1H Acc 70c' (• I -In - n IS <br /> LEGAL for new construction: Short Plat/subdivision '`i Lot No.7 (attach copy of long legal description) <br /> OWNER Cll-It Eg.4.44 P3:tJlf,A Phone/E-mail`0-5-`Ih), !{ul[,tt; ,l.uT <br /> Address.3j7 I b'�-�f 57- 5 w 4}'T i.,)-8 City/State/Zip t_`(/L/✓'vvi,,,,,l t W A <br /> APPLICANT: 1( Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PIC tilt 6 3 gu-k -4 -(Y144_ <br /> Phone/E-mail 1:,o Q,y0((„/}N A tt iely 01,5;12✓c-1 D4/•�/�r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 110 c, <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building ;_cSii1EP O*L Gas X Electric_ Other_ <br /> Building type: X Single Family _Duplex_Townhouse Multi-Family _Commercial <br /> Type of project: ,Y New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> i1L'v QUIl.4) 5144(rLt FArtll,'t t{cM( 04 ExIsr1'c- m o'-. W''`lI, ).Le SGl-f . Cdvele14 Pot- A 14.317ii;'.FT• bl,v,r- <br /> Javtt ' k24rot\ spot L-4-e 41 Le <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: X 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 3 Toilet <br /> ( Forced air systems l Bathtub <br /> t Gas piping 3 Lavatory(wash basin) <br /> 1 Water heater l Shower <br /> Gas fireplace t Kitchen sink&disposal <br /> Gas range l Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood I 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 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.1 1/, <br /> Owner/Authorized Agent Signature Date (Revised 6/2072) <br />