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0 <br /> 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# PE MIT# <br /> Z-�.= 2r'-f ��; S 4'„ Vie';. �e 7-ZC-,de,i° <br /> LEGAL for�new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER L_�j 'e �Ci+ j 11-� 1 L-4:— Phone/E-mail <br /> Address�e'' (�'L`:,-: 1 �'-r +���a1' City/State/Zip <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 = r 7n — : L&I LIC.#`� '—,,Ips` fes'' COE Bus.LIC.#6S E T�% <br /> Address 1 I I Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 1 rJ 1.i1 t�s Phone/E-mail 7 ��% r"-i L <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK e,dnc�f.i <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 ddition _Remodel _Repair T.i- Sign prinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 1,.1 S ,—�`,.�rr--�,.." _�',/�t r.i e�ZZ�2'� +�z:� ,�(=;..J �;�—�I G,'� 't��a i e.-,'�r,-�-Ga �1 ti ►if a i✓ . <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 I 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 pr perty 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 /> 2�7 <br /> Owner/A orized Agent Signature Date (Revised 6/2012) <br /> i / <br />