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• • <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# PEAMIT# <br /> 6 2 Z L90#1 no 07 vo 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER r,)Y'. Inq' Z, t-LZ Phone/E-mail A Gtdf <br /> ,- ,cb <br /> Address _! �l{, 11,7-0Ave NC- City/State/Zip r d+J,/ ky <br /> APPLICANT:—Owner JkOwner's Agent Contractor —Contractor's Agent _Tenant(must provide Letter of consent from the owner to do work in the space) <br /> CONTRACTOR + VVI L& I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> AIN Phone/E-mail�� Fotk, 04"WA s1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building ' <br /> HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other_ <br /> Building type: _Single Family Duplex_Townhouse —Multi-Family X Commercial <br /> Type of project: New Addition Remodel Repair / .1. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): ?. <br /> 0L7$5 ��•fOo{"StUt� D� ,dl�'dl WhiC4i� �;,? S /5 G� ! e� Xwnvr <br /> (L 1'IF.W DQiIAQ ' y1 0. �91^C V�Gic Q� 6��C(h�G!/,�rU3v1 •SrYL�LF.�►�U'ac Q d . <br /> 5 -b 17i� tr'uUtz °b <br /> MECHA ICAL PERNtft APPLICATION Ll I/ PLUMBING OERMIT 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 /> &L4- " .6, 112-- lLl `/z <br /> Owner/AuthEo_r1izedlAg t Signa ure �./� Date (Revised 6/2012) <br />