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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: PROPERTYAX# <br /> 91-00 iV '2-eo 402-0021909 0 I rirr162-a-r\ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> -- — OWNER - <br /> -�®},2'���-l�l��i� — Phone/E-mail- `"y,--y-�._._2..�..�-- <br /> Address fj`BOO 277 city/state/zipt;r-kjvik g$2,0 <br /> APPLICANT:_Owner Owner's Agent XSontractor _Contractor's Agent"Tenna letter of consent from the owner to do work in the space) • <br /> CONTRACTOR iVj��`{� M,9 i'N - Lp✓&I Lic.# Si„f O 5 CCO,E�Bus.Lic.# (j(� irrulvi• (j•./. <br /> Address gvfV t,1° - t4-5r' viz }•)hti{)l� -1 �g (Phone/Email42,5-L,1 Z_v93.t/ Z7 Mfnj'�VNWS024 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> j M. —492--05 <br /> 4) (-14.5-1.M eiti:kJ AcAtivAX Phone/E-mail __71', ✓Jr 1 e )43(7.- <br /> BUILDING <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t(fit/ 3w " l <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building SIYU Gas_ Electric J Other <br /> Building type: _Single Family Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: _New _Addition Remodel _Repair T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): �- ��,,rs <br /> " - 1h�i7.11 �1n) co'LI �it� a ,,, ] (2.) i 4:6)‘-ex's ) <br /> l.) ✓ `9V��� �nw r dwi--'1. U.t l (1.5'406-,414-116-A I ttAi P'6 f'S / d v>/s <br /> v4.)1-t,v<?irl <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 /> 1 0 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 /> i-_._- 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 ermit-does not resumeto`ive-auth Ytovioiate-orcancetthe provision of-an -otherstate-or local-law-regulating <br /> constuction—- - - -- <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 /> 2-Ab/I-- <br /> Owner ho;' •gent Signature Date (Revised 6/2012) <br />