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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# # <br /> 41 Ti C-&c1c - Avg cog 11 (x)2-1c6 l�b2 0 <br /> LEGAL for new construction:`� Short Plat/subdivision Lot No. 1(attach copy of long legal description) <br /> OWNER VNTA Clll�(,Qlm(1� Phone/E-mail as47j1`14 ...,.A \ <br /> Address 91271 ericaner Ave_ City/State/Zip Eve7(2\-k- k U1/4.A. ggao3 <br /> APPLICANT:_Owner _Owner's Agent XContractor _Contractor's Agent _Tenantn (must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR NI ce wv. , L&I Lic.#C�e G�H 22--k,( COE Bus. Lic.#0(04 <br /> Address g-()5 ss gc Seu#kew Cl�� 1 Phone/Email , t18 4 tStg <br /> TENANT BUSINESS NAME `' CONTACT FORRMIT <br /> / CreeNNWOCX. leu�l A4C <br /> �\7C Phone/E-mail (c p)-) 115 IX <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK' MW) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Elect Other! <br /> Building type: 'y Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: X New Addition Remodel _Repair_T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTIONOFWORK(additional space provided on the back): <br /> -Shu\\ S\cJ zone d.Wiesc, Vet.0- mP. <br /> 1• . bdt° VA zeLIdsLA . \Z\ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: XNew_Addn Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—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 /> r 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 author(;d by%% ner 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 /> 1911V 1/3/bo1-1 <br /> Owner/ uthorized Agent Signature Date (Revised 6/2012) <br />