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r <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St.1 Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S rE ADDRESS: PROPERTY TAX# P RMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. /l Q(attach copy of long legal description) <br /> OWNER RCA6\f4{ ki/� A 1)/y�N2�(0,(/ Phone/E-mailoW6) 6 . 8.5,_�/h>i.-V c2</8 <br /> Address2/ -7 l 9-5�A2(lf (4) City/State/Zip /" / i4 (A.,)64 9f) 020 <br /> APPLICANT:,)Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(rnust provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Ow'1'1 L&I Lic.# COE 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: C)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 /> Demo 5 F K <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 I 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 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 wo Ic ich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. `l,z, <br /> , ,0001 :0,... _- - " <br /> Si <br /> .� 8/..22.64)/201)7 --- <br /> ,.,-.,i,,,,-4 Rand 71 <br />