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SERMIT AP <br /> PLICATIA <br /> BUILDING/MEC HANICAL/PLUMBING/SIGN/S PRI NKLER/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: I PROPERTY TAX# P [I# <br /> LEGAL for new construction: Short Plat/su division Lot No. (attach copy of long legal description) <br /> OWNER" / llwz f hone/E-mail �2 S `j ! 622 <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 do work In the space) <br /> CONTRACTORState Lic.# Z 2 61 City Bus. Lic.# <br /> AddressC" fes. 3 Phone/Email 2 .�4 �a ,v rf dyr,t <br /> CONTAC�TT FOR <br /> /PERMIT Z / ''I7cr,.r+lnn T SiC�pr,3�.C ih <br /> Hal ����� G)-ye"(e Y-e Pho e/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: ,_Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition _Remodel _Repair_T.1. Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Tn!�f,-1( 04Un el �,.S, wa l l <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 I 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 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 a ized by the owner of this property to perform the work for which application is made and I comply with the State Contractors <br /> Law 16.27 RCW and 296.200A WAC. <br /> Owner/Authorized gont Signature i Date 6 (Revised 4/2015) <br /> `�v <br />