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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 /> r, '0 <br /> SITE ADDRESS: ERMIT# <br /> 0-0 1 W�Lii u r �`r PROPERTYTAX Tia- bl 6---VD PC.14 o�— O () <br /> C o <br /> LEGAL for new construction: Short Plat/subdivisior>ST N 10H01-AS • Lot t /) to (attach copy of long legal description) uj <br /> OWNER PAUL 4 W I NJ I R-4-tJO4-Z7-Q Phone/E-mail C+ 3 I`f- —p3 F(34, <br /> Address a t. <br /> DO I 1,U A' N L,L.1 sr". City/State/Zip 1 vE12-Gcr- WAY c?.o I <br /> APPLICANT:_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 W A-UC4a12 LAD K6r, 1....1v) j tJLr L&I Lic.# WM4<C-y-89 if DA COE Bus. Lic.# ' <br /> Address I S S+ # L4 3 MAo'Ly SV l L.L.E. $?7 0 Phone/Email(5k) 391 r (z-D <br /> TENANT BUSINESS NAME WA ONTACT FOR PERMIT StiE/tz ��e_u__ �1 <br /> N A ►.L1 t9►-�� s 5 t �I� LL C <br /> Phone/E-mail Lf-a 7t oZ 3g-C.Jo�O 0 <br /> BUILDING PE MIT APPLICATION CONTRACT PRICE OF WORK I v) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building S l 1\)(TALE Gas_ Electric X Other_ <br /> Building type: X Single Family _Duplex_Townhouse _Multi-Family Commercial I•11 4 u 1 e# -t ., <br /> Type of project: _k New Addition Remodel _Repair—T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> PLA 'l E tn) rni -t 1 L F- cru a o 1-1- YY-E- <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: W � <br /> Number of Heads Other: �.6f7 �/j t_Q <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. / <br /> j/ZA4E40,0147/431. <br /> Owner/Authorize Agent Signature Date (Revised 62012) <br />