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PERIIIHT APPLICVliON <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/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#00,t , P M T <br /> rlO/ Ave «� �� I UB <br /> co_ �r,rlaa <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ _ (attach copy of tong legal description) <br /> OWNER The Eve''et Phone/E-mail <br /> Address 360 /t City/State/Zip Eierett, NA P320 <br /> , <br /> APPLICANT:_—Owner __„Owner's Agent Contractor __Contractor's Agent ___Tenant(most provide a taper of consent from the ease,to do wars in the space; <br /> CONTRACTOR Tne Everett Clinic L 8 I Lic.# 'dire O'wner-N/A COE Bus.Lic.# <br /> Address 32 G/ Ave. Everett ✓N ,-,Sant Phone/Email 423-25c1-I}vim <br /> TENANT BUSINESS NAME lOvt%P r- r CONTACT FOR PERMIT <br /> rC"o=: ,.If1C ..caret Mond° <br /> Firs N1G111 Phone/E-mail 42,-B23--22Z <br /> BUILDING PERMIT APPLICATION ' CONTRACT PRICE OF WORK`vi� � v .✓v <br /> (v) <br /> Existing Use of Building„�_�i_c_^�; Of fsice c cc HEAT SOURCE: <br /> Proposed Use of Building'``edicoi OCrice Gas Electric_____ Other__.__._ <br /> Building type: Single Family N_Duplex___Townhouse ___Multi-Family 2,_Commercial <br /> Type of project: ___New ___Addition ,_,X_Remodel __Repair., T.I.__. .Sign___Sprinkler___Demoition..___Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> OF 1iIIOR Ai.-'e.:- 5 '�AN ECi., ,::, ._ .. EXTER;CR NNOR< _R CRS T <br /> 4'. _ CASEWR \E;; R. _LDE. 'ETAS. STUB <br /> _ ._ _ .. = .:.6::'36 SYSTEmS, AND F`R£-LiFE SAFETY SYSTEMS AS REWIRED 5T hi'. <br /> PiU"BONG AND FiR CFE SAFETY SYSTEMS T:'OF S:DDER DESIGNED, BY DEFERRED steirrri_ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ___New ,,_Addn __,-,Alteration_Repair Type of Project: _..,.._NewAddn _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 Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mopietc.) <br /> Heat pump 1 Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove ( Grease trap <br /> Ducting ! Roof drains <br /> Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other: <br /> Number of Heads Other: <br /> t hereby certify Malt has read and examined this application and know the same to be true and correct.Ail gravis:ons of laws and ordinances governing this type*tweet will be complied <br /> with whether speciti:• •rein or not.The granting of a permit does not presume to give authority to violate or canted the provision or arty other state or local law regulating construction <br /> Th tenon ,�y.wner of t .o .• • work for which application is made and t comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> /�: �f� — <br /> .11P <br /> Own. . !zed Agent iii' Date (Revised 612012) <br /> Vz <br />