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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: 020 yc Jy JE Q{ PROPERTY 28Q5ZD00ZUZIDO P4I I #_ -6 a <br /> LEGAL for new construction: Short Plat/subdivision lJl Lot No. (attach copy of long legal description) I <br /> OWNER 5el %( Cccmoy, ReAIit1 CCflklr Phone/E-mail <br /> Address tot-to J fSor1 6.-I-„�/ City/State/Zip $eti' 1 /W1' (76206 <br /> APPLICANT:_Owner _Owner's Agent X,Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR CFM Nearyl l:O41) L&I Lic.# CFM I4E14070gGO COE Bus. Lic.# <br /> Address V0. X- 5z-05"--)1K\( dantlt It,,- 96083 Phone/Email 1/25-62/-124,3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT eA As <br /> re l ler <br /> 5e0i far .Fvere C kt ni C /! <br /> Phone/E-mail 117-0--01-/26jj/ Teirentye CfM .avti <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2o,000 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric X Other <br /> Building type: _Single Family Duplex Townhouse Multi-FamilyultX Commercial <br /> Type of project: _New Addition Remodel Repair(X T.I.T Sign__Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): pe,04,e2 ex`s,.-, r p 44,t, �acica heo/-f- <br /> po 5 Wi -tn (\&& 3a1,Yve Size. 1 5a►r2 i©te,410 l f roo'- k' pumps. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn XAlteration Repair Type of Project: _New_Addn __Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units I • Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ranee 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 /> 4110 / ' �� /1/(-4 02,/y_/3 -� <br /> Own- /Author' ed gent Signature Date (Revised 6/2012) if ( / <br />