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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 DRESS:, * !f n PROPERTY TAX# PERMIT <br /> /td' -3/ /:° /-ri I . y 6 Q(c-'/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER kr", Phone/E-mai(ci&C?0/— O/ 7$ <br /> Address//�/ /j?' ,4 City/State/Zip ne////Ar,,,.. <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 `h 4,."er //l Ct?mirAea(if L&I Lic. CC4.70 , 2 COE Bus. <br /> Lic.#osa <br /> Address ea/art/46"r/ c ,rq ' 067..2 Phone/E 7 )0>— 1/47/Ag/,i � .1r4„C" <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ..5/.4'-- 4.1 del 5-6-1 Phone/E-mail pp <br /> BUILDING PERMIT/ 4T APPLICATION CONTRACT PRICE OF WORK f � 5—elen <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas 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 OF WORK(additional space provided on the back): <br /> –7,15/–Ag 5:e Civtd Corsa 1 � / of 0,4 1 <br /> 1 e—A1 SPf //� <br /> 4-Cot 44- <br /> c <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 I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> 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 /> X;/'Z'e/4'cl,? t/.) <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />