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• <br /> I <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 /> 9,�� „1.,„..&„ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEAQDRU(� 61, NG. / A ).1)i PR F3R4 � s6,06.0� Pii�J#161 -br�� <br /> LEGAL. onstruction: Shbrf Plat/subdivision N yc (, ` �Njo. (attach copyof longlegal description) <br /> �l � _Lot g sc Iption) <br /> OWNER r ••tp L ' i lL. L` "$ 4t Phone/E-mail k4 " Z to. 4`I-7 0/b lYl G/a.IA <br /> i1'b� LCANYV <br /> Address 2,(1,03 1 t♦13VILA_ / IVU City/State/ZipEJt (.( W /a•%zip 1 <br /> 1 <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� A cL�c..�ll �'ZIL L&I Lic.# COE Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CQNTACT F O P RMIT <br /> Phone/EE G 1/j 1•g yZ 40,4AA, e. 1,,, *. i e- f�Jt <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKJ (6( )OO <br /> Existing Use of Building r 4.5t a wv 1 ` HEAT SOURCE: <br /> Proposed Use of Building wit t• T Gas Electric ,/ Other <br /> Building type: ✓ Single Family _Duplex_Townhouf Multi-Family _Commercial <br /> Type of project: New Addition V Remodel V Repair T.I. Sign_Sprinkler_Demolition_Change of Use <br /> DrprgJ WO 6i�aF� roov/ded r a bac : � j IUD IAA"Lei ,6„.6,444--- �-- <br /> �. <br /> c--onen _i --4,1--1-tr-fl 0\7-t'ill St}-A-ak""' I rtplakft 5take-\) <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 /> — <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 /> I Ducting Roof drains <br /> 1 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%LJ <br /> 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 /> / Ci ��:4_ //"G19,—/' <br /> Owner/Authorize. Agent 'ignature Date (Revised 6/2012) <br /> 1:2 <br />