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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 /> SITE ADDRESS: — PROPERTY TAX ft P MIT/i <br /> /11h� r S (j 1D'1 -1 .?,D4-- 0611 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER , L c X Pci A -C.,7V Phone/E-mail A{Z S 3,2 <br /> Address 12 ? c J _ City/State/Zip t /A - <br /> APPLICANT: 4,^.PCvner Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter or consent from the owner to do work in the space) <br /> CONTRACTOR State Lic. # City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building-- Gas Electric - Other_ <br /> Building type: Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: New ,..1 ion Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Pe- - 0 L >t-K) � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Adds 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 j Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater j Urinal <br /> Boiler i Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 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 /> i2 /2- // <br /> Owner/Authorized Atent Signature Date (Revised 3/2013) <br /> 1 <br />