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01/05/2016 21 : 10 17740 P. 002/002 <br /> • 0 <br /> 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 /> SITEAD RESS: T ROPEKYTAX# MIT#r^ <br /> LEGAL for new construction: Short Platlsubdivislon Lot No. (attach copy of long"at description) <br /> OWNERAt:( CQ -zPhorte/E-mail 2­ y-Ztl <br /> ddraes X city/Statwzip <br /> APPLICANT: Owner _owner's Agent contractor _Canbactoes Agent Tenant(must provian a Iutier or conannr!rein u n uw erm aowon and eoace) <br /> CONTRACTOR r Stats Lic_# �AVel City Bus.Lic.# <br /> Address Z AM- Phone/Email <br /> TENANT IJtJalNL5,5 NAME CONTA( 511PERMIT <br /> (3b NU q2 <br /> Phone/E-mail <br /> 13UILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building� � HEAT SOURCE: <br /> Proposed Use of Building C`i Gas 4---Electric other <br /> Building type, Single Family _Duplex_Townhouse T Multi-Family Commercial <br /> Type of proiact, New Addition Remodel Repair T_I. Sin S rinkier Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the eac;c) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ,._New_Addn "teratton_._Repair Type of Project: _New_ Addn _Alteration_Repair <br /> Show Number of flxtuma show Number Q# of Fixtures <br /> A/C—air handling units Toilet <br /> Forced airs tams Bathtub <br /> Gas pipi Lavata wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink servicelbar/mo leto. <br /> Heat pump Backflow preventer inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refriantion Floor drain <br /> Woodstove Grease Fra <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Qther, <br /> Number of Heads Other: <br /> I Hereby cartity that I have read and%nmrrunnd this application and know the same to be true and correct.X1 provisions of laws and ordlnances governing thiEi type of woA(will he compl <br /> with whothcr soiWiiect herein or not,The granting of a permit door not presume to give authority to violate or cancel the prgwilion of any other stats or local law regulating const eon <br /> That I am au od y p e 0-ner of thA property to perform tho work for which application is made and I compty with tho Stato Contractors 1-aw 18.27 RCW and M.200A WAC. <br /> l /"/, //Y <br /> 0 or/ rued Agent Signature Date (Revised 4/2015} <br />