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<br /> PERMIT APPLICATIGIu . ,_.: ,
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKL RI.DEMS}.LI_TIG
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> , 5 2013 U
<br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-885,7 ::, .www.everettwa.org
<br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO,4 PM, iit j T Tr, .V,")V,,
<br /> SITE ADDRESS: PROPERTY TAX# >' IT#
<br /> /733 -/o o '4 ,.5.f. #.J !O� 59,o oc nv/ Ya : -ORM.S 30 3— O 17
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attaCh'Cbpy of long legal description)
<br /> OWNER,,.//t.V .,,? 4/47.4• "/20 cf.vTe_',,Q ",g/r7 Phone/E-mail
<br /> Address /p/45- - ,,,$e a �7. ,. e• City/State/Zip ��vG�ri ten,S N 9/?9,C
<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 '1_1/i», /6-44.AS L& I Lic.#A4Ie, ,3 5/O 770,s COE Bus. Lic.#
<br /> Address 9d9 . c=")1,w-- .j7-- 7 .dd•,2,9- 9-f ye9 Phone/Email c-�•X73 3.33
<br /> TENANT BUSINESS NAME / CONTACT e_
<br /> FOR PERMITE�, o
<br /> J`�TJ ..A3-,3 --Se 3 k ,S.
<br /> 9Tf �`� '��K /moi!/ y ``L7!ti Phone/E-mail dd/1//y/g_ y`-1iC.Ll..ry6'cz. /8ss✓S• eGA-'l-
<br /> BUILDING PERMIT APPLICATION PRICE OF WORK �,� 'S ca
<br /> Existing Use of Building /�.St�,t�,yy✓ �)� HEAT SOURCE:
<br /> Proposed Use of Building _\/.51/12-,#>t!1'? .,..._. s'--I.,---P--S Gas Electric Other
<br /> Building type: Single Family _Duplex Townhouse _Multi-Family )V Commercial
<br /> Type ofproject: New Addition Remodel Repair T.I.)C' Sign Sprinkler Demolition Change of Use
<br /> DESCRIPTION OF WORK(additional space provided on the back):
<br /> 9 h+ Walt Si j h
<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:
<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 /> •__ If , �--DO
<br /> •wner/Authorized Agent Signa4' Date-) (Revised 6/2012)
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