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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 vwwv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: �-d PROPERTY TAX# P RMIT# <br /> 6000 23 Pi- W 2r(0410200301 foo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER N j 1 l A frJ %ec-A Phone/E-mail <br /> Address (oOC)G r-C? 01- W j,WCtf U/ 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 L&I Lic.# COE Bus. Lic.# <br /> Address Po i+rl ot- Fre Phone/Email ZS 3 ' 2 ^6 / 5 0 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> -Oavivi (A•-fat--e4sd+� 253 922 -6150 <br /> Eoe[ T2 GtG 7�7JC Phone/E-mail davM.Ghr�ste.7san a{rrotl�rrC•�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK g,000• D O <br /> Existing Use of Building 1^✓are° "SSG HEAT SOURCE: <br /> Proposed Use of Building 'Warr- kW L4Se- Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family ko-1-Commercial <br /> Type of project: New Addition Remodel Repair T.I._Sign A/Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): /nodi fy ex�`Stlrlg S�Or%✓i k ler SyStfi k, <br /> to /IOra�vfd& CovtG' pe— for— ^&-v Ai�la✓+G �r,&t"G vnock - 44? . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: NewAddn _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 /> 21anw/ 5 <br /> Owner/Authorized Agent Signature Date vise 612,Q12) <br />