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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# PERMIT# <br /> 35 � FE tPL AYE -, ' <br /> LEGAL for neve construction- Short Plat/subdivision 91tu'AWr RDbf'776r/ Lot No. (attach copy of long legal description) <br /> OWNER m —Phone/E-mail C,1('k RAPEKIO •Go ZS' • 3 <br /> Address 35Z$ t-�a It}L City/State/Zip ��11,Iz Tf OZUI — IV <br /> APPLICANT:__Cvvner X Ovmer's Agent Contractor Contra Agent __Tenant(must provide a letter of consent from the owner to do+rorkin the space) <br /> CONTRACTOR "T-gb L& I Lic # COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> UK GRll AF�R�RaL��OMED�5�kN5�°�f�/►1A�C.�aM <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ <br /> Existing Use of Building HEAT SOURCE. <br /> Proposed Use of Building_'�//lAtbIrIY SCr�i� GasJO Electric Other <br /> Building type )CC 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 /> WAN Skfk 25(�-- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: Y 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 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. Se VVvr (� � <br /> I hereby certify that I have read and examined this application and knowthe same to be true and correct.All provisions of laws and ordinances governing thistype ofwork will be complied <br /> with whether specified h 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 authorize ythe wrier f this property to perform the work forwhich application is made and I complywith the State Contractors Law 18.27 RCW and 296.200A WAC <br /> 4*13 ' <br /> OwnerlAuth d en S' ture Date (Revised 6Y12 012) <br /> Z <br />