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k <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (34_06,Fagot i r-e 16-b -044) <br /> SITE ADDRESS: _590 I 7.3143 DR, y ir..5— PROPERTY TAX# Palma# <br /> —a4=ZF:--ri,,JA ciS 3 0�c�ir.i'� l4 'PROPERTY <br /> 6.6-0 6013®4100 'ist( -6 (D <br /> LEGAL for neweconstruction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER N EEC, 3ii-e_34 U Phone/E-mail ?E.Ai4 )4,J!1 Q_ ime.-.0 .-r, /4 a-.• <br /> AddressI-193 Z A E.9f _5'', _E.A-t^R 0 A- City/State/Zip ,f tsjA cj$I Lc— <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 /> CONTRACTORCONTRACTOR 3-r-ctijArzir FI+r 1f'lac r'i,,,ii LIG L&I Lic.#£-MdAf P S9 3 F COE Bus.tic.# <br /> Address 1 3 /00 0 i 6 RD. . -.49)-10 km _41 1nsi¢ (31,,.9 O Phone/Email 6-rm.v)AGS-TF i iir15 �Li.1i'-,efJrvt <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT alk 11_,11 F s_y <br /> 1 AC tni, .S $ice.s- IZZ 3 ZI <br /> Phone/E-mail i=._yvt 1 i-b(, 11-f'€ Li 4 a, 49w1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4041C)4),°'" <br /> Existing Use of Building a 4- .5.1. HEAT SOURCE: <br /> Proposed Use of Building _ / I Gas Electrics Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family Commercial <br /> Type of project: _New ,Addition _Remodel Repair T.I. Sign )fSprinkler Demolition Change of Use <br /> ,---., DESCRIPTION OFqWORK(additional space provided on the�b^ack): _ <br /> Abo 1 i4Fi.9/ 1 n4IL 1-rE 1� Fiz F i Pizee r� /Jai,u► 6wi s,_ ci gal , <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 /> I 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.)Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> _ <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> INumber 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 1 am authorized by the owner.f 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 /> '"I/ <br /> Own Authorized Agent Signature Date (Revised 6/2012 <br />