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FI Di 20/2010/FPI 11 : 42 AM Norfill � eek hoofing FAX No, 425 4[ n524 P. 002 <br /> PERMIT APPLICATION <br /> BUILDING/1VIECHANJCAL/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 /> 2LEGASITE ADDRESS: ‘.6 <br /> , �,r PROPERTY TAX# �+ T _ CZ- <br /> LEGAL <br /> L for new construction: Short Plat/subdivision Lot No. (attach copy of long Legal description) <br /> -14 <br /> OWNER v \ / C \ Phone/E-mail IjS -�`'( Q <br /> Address 2232 V Vi 1 A O\ U City/State/Zip Ev;Q[&k• - i 00a2C <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent _Tenant(must provide a lettere(consent eom the ownerto do tt tae space) <br /> CONTRACTOR U(k\AGCQ L L\r\,, — L&I Lic.# \ NI.AkkL W LL U, COE Bus.Lic. , f217 l <br /> Addres` J � I � l�2 <br /> catt2 Phone/Email -(/LA 3 - <br /> � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT y.. o_dr•sx,. <br /> Phone/E-mail -1-Ari/c"---K253 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK to <br /> Existing Use of Building HEAT SOURCE: <br /> • <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: ngle Family `Duplex Townhouse _Multi-Family Commercial <br /> 1 <br /> Type of pr ject: New Addition )(Remodel T.l._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> `St--OAf t Cs 1 tru-t,-( � f-u4.9. \ - <br /> C I r u e U`s , <br /> • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project New Addn Alteration_Repair Typo of Project: New Addn _Alteration_Repair ... <br /> Show Number(#)offlxtures Show Nt<nrber(0)of fixtures <br /> NC-air handling units ( Toilet <br /> Forced air systems Bathtub <br /> Gas_pipino Lavatc y(wash basin) <br /> Water heater J Shower <br /> Gas fir place I Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood I Water heater <br /> Exhaust fan { Sink(serviceTDar/mo /p etc.) <br /> ( Heat pump I Backflow preventer <br /> Unit heater j Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration I Floor drain <br /> a ( WoodStove <br /> I Grease trip <br /> Ducting I Roof drains <br /> Other,_ Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Other; <br /> Number of Heads i Other: <br /> I hereby certify that I have read and examined this application and know the same to be we and correct.Au provisions or laws and oniinances governing Nis type of work will be complied <br /> with whether specified herein or not.The granting of a permit doss not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Thal I am authorized by the owner of Ude property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> j�✓I a-z- t' .tg <br /> o !Authorized Agent Signature Data (Revised 6/2012) <br />