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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: PROPERTYTAX# PE I <br /> 5 �Jcic� 'Nvt or-19 300 yLf C10 7C1 >t 7 ( -./1 <br /> LEGAL for new construction: Short Plat/subdivision Cye-r j i•- D+V R RA( Lot No._1,65 (attach copy of long legal description) <br /> OWNER ; ,t.. ,f[ Phone/E-mail q2 5-- 3 1 c.J -&`(CJZ <br /> Address I 3 I 1R u c' ue- City/State/Zip f^(,f Z.,Y-f-t-- tIA q cC ZU J <br /> APPLICANT: Owner _Owner's Agent _Contractor —Contractors Agent _c Tenant(must Provide a letter of consent from the ovmer to do work in the space) <br /> CONTRACTOR c)u,,,(V k'eU Ccgxt-f NC--}0f-S L&I Lic.# SCJV�u O CL,9 S I K- COE Bus. Lic.# <br /> Address -j�i'cG'1 Phone/Email 1-/2S �1 7v 7Z`f 7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT N/,,+-i- tc <br /> Phone/E-mail '7n214 -7 <br /> 7n2c( 7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 11,20, 000 <br /> Existing Use of Building -S l� � HEAT SOURCE: <br /> Proposed Use of Building S t- tZ Gas-K- Electric_ 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 On F WORK(additional space provided on the back): 1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New ddn _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 /> t Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> t Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer l Clothes washer <br /> Range hood ater <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 to perform rkitsl which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> _7 V <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br /> V271 <br />