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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 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 3 / IA S7. SC , ,t-✓e-rigtIt- zgvr2liooyOOxOV DLO 1367— Ola <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER £a r l 0 9` 1'kr'a K y "Setup n Phone/E-mail 3 '0 B ,a-3.17"Sc?ar/.6r.trefreec w wt.t.ely <br /> Address Z i D q L. s a L a n A City/State/Zip /3 e //,f K, AQ ti.. WA) 48"2.29 <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 C tN K e r- L&I Lic.# COE Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> heik r ( e e tet so n <br /> Phone/E-mail ? 60 ,itJD 7 3 7 s' eqr/,je0,-,,. Wwot 94 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Ga rni E 9- Ater eV HEAT SOURCE: <br /> Proposed Use of Building pi*Ii1 v `' ..r it" 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 L/Demolition_._._Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> de#+se(.'aAi 7 av-aPz 20. V # Y 2. <br /> of a a4.,a(.'s L a eft a is k G 3'*4ic4 re to r,q,471 o f f9 g rave 6 /prZ.2- <br /> di , <br /> r a II •-i1✓uch,(res /6 tkuo 4 AI 4 C Gf <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 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 /> 2a.4,.-, / '�,i *.c 7-Z 3-/3 <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />