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PERMIT AI'PLICATI <br /> 1°' ® <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: ti�S PROPERTY TAX# PERMIT# <br /> l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER Phone/E-mailylS--35�- vo <br /> Address '� rCity/State/Zip <br /> APPLICANT:—Owner _Owner's Agent —Contractor —Contractor's Agent _Ten ant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BU-51NESS NAME 2 -�-- CONTACT FOR PERMIT <br /> / �W� � Cu{n yip <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION` CONTRACT PRICE OF WORK OtS, <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.I._Sign_Sprinkler_Demolition_Changge of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PE IT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project=-iiew_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 y 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 /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby c rtify 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 /> wit e e 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 orized by the 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 /> O e nt Signature Date <br /> Revised 4/2015) <br /> �2 <br />