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*PERMIT APPLICATICO <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: .,, �, -j � PROPERTY TAX # PERMIT # <br />LEGAL for new construction: �Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER ����F� 170��/%U�j AL/%�Ile Phone/E-mail �12 5-2'-'� Z ' yoZ Z' Z- <br />Address?4 Ze Y' City/State/Zip AI�4 <br />APPLICANT:, Owner _ Owners Agent _Contractor _Contractors Agent _ Tenant (must' rovide a lanai or consent from the ovner to do work in the space) <br />CONTRACTOR NState Lic. #tct lU I Z CitV Bus. Lic. # <br />address Phone/Email <br />TENANT <br />BUSINESS NAME CONTACT FOR PERMIT ryN� Y �/E-�T��— "� G Phone/E-mail 2 S- S }�ej 7a��r <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /�O o, 00 <br />Existing Use of Building 5-1cieHEAT SOURCE: <br />Proposed Use of Building �FjQ Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />IType of project: New Addition X Remodel Repair T.I. Sign Sprinkler Demolition Chance of Use <br />DESCRIPTION OF WORK (additional space provided on the back) <br />MECHANICAL PERMIT APPLICATION <br />(Type of Project: _New _Addn A Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Gas piping <br />Water heate <br />Gas fireplace <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory wash basin <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer inside bld <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be We and correct. All provisions of laws and ordinances governing this type of work will be comp) <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 Oy 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 />Owner/Authorized Agent Signature Date (Revised 42015) <br />