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ERMIT APPLICATIOM <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# IM^RMIT# <br /> I(tol SI4IktL54i0 1,441 Z_S�Lt 0 1 0 0 3 0^ 21-00 !VL 12-0dI-02� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LI;A- 4/}ay Phone/E-mail <br /> Address 1190 i Voda jLkLvtvfL ' Swi-ri. 419 City/State/Zip TitAil)Jtc, /r" <br /> , � o`Z(4'i <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 A,LT 1" ,,(1,14.1A-N1IJV.L ,xw 6, L&I Lic.# EA/ATV/II j(0.36141 COE Bus. Lic.# 1'1-3t' <br /> Address gL3o 153 az /h' rL Wt.�yl/,t f L)j� q � Phone/Email lch�3— 'My <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT filoI Ciftita- A-7000) K12-65' <br /> �j �tif.OSP4 ZEST' U -P, Phone/E-mail y�Tl_IUDt��IAA uLtimuw4AJtt.LAL•Cb <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKS 2.—C r Obo .vv <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): Ste -Lt'.STPrLt- (i) (+E -T 9k n P ,yS7i I.-) IW Coq)/ ( <br /> Pcti Dl�Jati ks-rvv+, /2LP/L1G,LR nri eq/0,4 P)11,vi1 141'vv'rl1)/77 &?),vrY2-vt,S• <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 /> if'j 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 /> (I) 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 aut orized by th owner of this roperty 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 /> OwnerlAuthorized A ent Signature Date (Revised 6/2012) <br />