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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 /> TE0.17 <br /> 3R G C IN a /GO✓ZL� PROPERTY TAX# `I�,0— y�,l, r <br /> LEGAL for new construction: Short Plat/subdivisionsiT _Lot No. (attach copy of long legal description) �l� <br /> OWNER a et /,J6 Phone/E-mail <br /> Address City/State/Zip <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 /> CONTRACTOR M01/1/' ? ca. 519-6-114 L&I Lic.# COE Bus.Lic.# <br /> Address /5'31-2, 17'0 erfl Ar 3 w 9rYI Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT rL2�„ '9 - 219'9 <br /> &06-1,46, Phone/E-mail L. dAii IAO IT/ti'6%'i ?cx. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 7,000 <br /> Existing Use of Building ,1e1 l G HEAT SOURCE: <br /> Proposed Use of Building 00r I c-.0 Gas_ Electric 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): <br /> j/V5141 , f Q-k Zs6 r/d-/tic/%-- <br /> MECHANICAL <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 /> 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.) <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 authorized by the owner of this property to peri•,, the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / <br /> 4,3(f/ <br /> Owner/Authorized Agent Signature 9 Date (Revised 6/2012) �`.a <br />