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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: 7�� q,to PROPERTY TAX# P,�E,R�1lT# <br /> 7 rt�'i,'e.. id,/- /ice 6 1 'Z OIL C��'CY2i'I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> :OWNER H-j.7.I L-c,,- ./4-(y 6ef.,v- /..-4/54- lH�. Phone/E-mail <br /> Address ' 14 h'40 cvtriv^i� Vc • City/State/Zip s l 6' lam-(' OC( /:2 0 <br /> APPLICANT: Owner Owner's Agent /Contractor _Contractor's Agent Tenant(m t provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR (.44/V pelt 1�/// /P,/!"7%fll0t1 L&I Lic.# (//V/vE/�f /2y� COE Bus. Lic.# O27 5 <br /> Address yt 2- / �C� lel/�rTu�t!✓tIi g8007- <br /> r, <br /> 802( Phone/Email I j/9N9 �G1/livBy�a/ fi c.:001 <br /> TENANT BUSINESS NAME CONTACT FQR PERMIT•-> <br /> s/ 75-i ki44,1 ' ' fcf-/'(, �'''7"'� hic{xf/7r Gl��,�a - <br /> Phone/E-mail X11 "-cpm-575-07 <br /> ,BUILDING PERMIT APP (CATION CONTRACT PRICE OF WORK 72`/0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas- V Electric V Other <br /> Building type: Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(a ditional space provided on the back): //-jam, 7 / c 1c L:/4,4/,_,) ci i a," <br /> r' �, ,x.,,,,,,„t /- �s <br /> 5 wf/ V 4 J ca..--e---t �uc wiiKK, (y e/mac. r,.�c Ve // Gr�.ater. / ,e(/) <br /> :1r5 74` G64It t` )Pc ' 1,..47 cTSSe l . :lam f 'f <br /> J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn \V 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 <r1.f-7( I2Ut( � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM e 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. <br /> l '.. ` <br /> OwneriAirfthorf d'Agent Ignature ( to (Revised 6/2012) <br />