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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 /> SITE ADDRESS: PROPERTY TAX# j ^ <br /> 94/CHI5tL� (AJ ,rUErZETT", (-oft qP,Zotl 0! D(ZDDD 100 �luE�1 L \ —O"U <br /> 'A <br /> LEGAL for new construction: Short�Plat/subdivision ��Ty Ls(7r/T Lot No. 247 (attach copy of long legal description) <br /> OWNER CO(�t.JEfZSfD�1F fft,r1 .4 /\jtAj L Phone/E-mail NZS 33�i"S�3'c / ��(�2A1Etz5TUNC(fn.i1c.05- <br /> Address Po j?oX / /(t'Zc/ City/State/Zip rvIrt.L t✓,,ZtEs4 LAM 5s°8Z <br /> APPLICANT: Owner X 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 CDRn1E2S1ti' 4OME5 /\44 L..L - L&I Lic.# C.o(2,A)C14 Nq_y7c4k COE Bus. Lic.# DLI q 197 <br /> Address po J p)c /t/LZ LI tilt Lc �� t.„, Q`2•O Z Phone/Email t-!Z C-3313-508 S08 feC.0QN6>z5'A I-Jv CS V' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT-.3-? URrn0zrvcrJ <br /> Phone/E-mail 1z,-73'30-5u /3 ?CaRN _RS, 6I ycs.US <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building NEW Cjt✓Q Gas X Electric Other <br /> Building type: \ Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: X New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> NEW sFIK t-/2/ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: )( New_Addn Alteration_Repair Type of Project: X New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units ,3 I Toilet <br /> ( Forced air systems 'Z I Bathtub <br /> Gas piping W f Lavatory(wash basin) <br /> ( Water heater I Shower <br /> J Gas fireplace I Kitchen sink&disposal <br /> / Gas range I Dishwasher <br /> / Clothes dryer I Clothes washer <br /> ( Range hood W _ <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 /> Th t am authorized by he 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 /> tI <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />