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ERMIT APPLICATIO. . <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 SOI062OZ PERMIT iii �� <br /> (=41 fes- ICJS5 ; c/(5-- FL/4C 511/ ol© 2-�Gb�JL of l ( l �`1- C, <br /> LEGAL for new construction: Short Plat/subdivision___ _ Lot No__ (attach copy of long legal description) <br /> OWNER 'Rr.75 ..1S-rL... E. Phone/E-mail 0.0 CO <br /> 2 25 t 510 <br /> Address /0733 se- 1X 74'A S Oty/State/Zip A),Aton 74'^ / (s1-1J4 , 9 */Q,�„ <br /> APPUCANT:_Owner ('(wner'sAgen __Contractor —Contractors Agent _Tenant t'must provide a letter of consent fromlhe owlet to oo work 11 t he wacet <br /> CONTRACTOROff . L& I Lic. # COE Bus. Lic.# --7'sv <br /> Address J Phone/Email SAntiE <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Ro 5 .r<-T C-1--A/M:7(o•1.1 NZ-CR("7-t <br /> 14-?--5 7-59 '2I�jCo <br /> BUILDING PERMIT` �APP'yLICATION CONTRACT PRICE OF WORK S 1 9-)) Ca5 <br /> Existing Use of Building VAfiI4 T L07 HEAT SOURCE: <br /> Proposed Use of Building 1-2, -5 I DE.N`(C CJE\ Gas 'Eleccttnc 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 /> N w R e S 1 PE.-- oJK 'A oK R <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> l <br /> Type of Project XNew_Addn _Alteration Repair Type of Project: XNew_Adds _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> AIC-air handling units � 1 t f Toilet <br /> X Forced air systems 3 Ile Bathtub <br /> Gas piping „3 I-* Lavatory(wash basin) <br /> Water heater I Shower <br /> Gas fireplace I 1 Kitchen sink&disposal <br /> Gas range I i Dishwasher <br /> , * , Clothes dryer I G Clothes washer <br /> Range hood I Water heater <br /> 5( ; Exhaust fan I 11 Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater c•) Unnal <br /> r Boiler (') Drinking Fountain <br /> Refrigeration drain <br /> Woodstove O Grease trap <br /> X Ducting (y /p,i-c✓.rtc1 S) 7 Roof drains <br /> Other____ Q 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 Al provisions of laws and ordinances governing this type of work wil be complied <br /> wth 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 bcal law regulating construction <br /> That I am authorized by the owner of this property to perform tie work for which appicatbn is made and I comply with the State Contractors Law 18 27 RC W and 296.200A WAC <br /> 112,___ <br /> -A -A\ 7/3/13 <br /> Owner/Authorized Agen gnature Date (Revlsed62012) <br />