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OPFE-RNTAPPUCATIOM <br /> BUIL®INGIMECHANICALIPLU BING/SIGNISPRINKLERoDE OLaTlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., 'Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> PROPERTY # <br /> SITE ADDRESS: PE� l 0 r <br /> EY TAX <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ("1� {F 13e. Phone/E-mail Z t-f 7 <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 Op work In the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail '1'f Z �,5-V b Z� 1 3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3y� <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 _Addition —Remodel _Repair. <br /> 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 /> 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(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I 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 correcL 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 /> e; <br /> Owner Aut iz <br /> (Revised 4/2015) <br /> Agent Signature Date <br />