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PERMIT APPLICATIUN <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 /> • <br /> SITE ADDRESS: PROPERTY TAX# PERMITT#�u <br /> 3006 /61-.c-t. � � .� lI o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ing legal description) <br /> • <br /> OWNEt %r t 1 1 PX ! "O ' `c^.4, L�.C.i7 Phone/E-mail 26x,-4,-7q-61.28 • <br /> Address 3006. <br /> w 6 / 0- c City/State/Zip V,,y�efj" ( Ulf 1T3 201 <br /> APPLICANTAOwner Owner's Agent ^Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR State Lie.# City Bus. tic.# • <br /> Address • Phone/Email <br /> "TENANT BUSINESS NAME CONTACT FQR PERMIT �(� {,� <br /> Phone/E-mail 0 1'V ?..—chjcv• L; 2 —k 1 V <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3s 0 s+�- <br /> Existing Use of Building L-[U . SFR HEAT SOURCE: • <br /> Proposed Use of Buildingl—f tl i s - _ Gasc_ ElectriOther <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 /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Repair Type a of Project: New_Addn Alteration_Repair <br /> Type of Project: New_Addn _Alteration_ p YP <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin). <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer; Clothes washer • <br /> Range hood Water heater <br /> Exhaust fan • I Sink(service/bar/mop/etc.) <br /> Heat pump Backfovv preventer(inside bldg) <br /> Unit heater Urinal <br /> r,Boiler Drinking Fountain <br /> Refrigeration Floor drain _ <br /> ' Woodstove Grease trap ' <br /> Ducting 7 I <br /> 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 m authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> Owner/Aut rized Agent Signatur Date (Revised'-' <br /> X Z <br />