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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIG NIS PRI NKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 9$201 425-257-8810 FAX 425-2578857 www-everettwa.org <br /> SIVE ADpiftE S )�� I[>— pOb(pb AX# � � PERMIT# 1✓ <br /> LEGAL for new construction: Short Plat/subdlvlsion <br /> Lot No, (attach cagy of long legal description) <br /> OWNER r O f n Ori <br /> Phone/E-mai! J <br /> Address <br /> City/State/Zip <br /> APPLICANT- O neer Owner&Agent Contractor <br /> Contractor's Agent Tenant(must provide a lever of consent from the Wer to do work in the apace) <br /> CONTRACTOR IState L;c-# i2` <br /> G;t Bus. .c. �d0 <br /> R d C)Add ass I t Phone/EmailTENANT BUSINESS NAME ID�a -a%4 g ' -4A <br /> CONTACT FOR PERMIT a�r v-,t k001�1 <br /> Phone/E-mail aA1'yv- LO <br /> BPILD1146 PERMIT APPLICATION CONTRACT PRICE OF WORK C� <br /> Existing Use of Building <br /> --�� --� HEAT SOURCE; <br /> PrOposed Use of Buiidiny <br /> - Gas Electric Ottley <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family �Commercial <br /> Type of roieot; New Addition Remodel Repair T.;. Sign S rinkler Demolition Change of Use <br /> DE RIP TION OF WORK*Jd/tional space provr ed on the back) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _Naw_Addn -—Alteration_repair Type of Project: New_Addn _Alteration_Repair <br /> Show Number of fixtures Show Numbq� # Of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs sterns Bathtub <br /> Gas piping Lavator wastl basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gas rancia Dlshwasher <br /> Clothes dryar Clothes washer <br /> Range hood <br /> Exhaust fan Water heater <br /> Sink service/barhno etc_ <br /> Heat purnp Backflow Teventer <br /> Unit heater Urinal <br /> _:::J� <br /> Boiler Drinkin Fountain <br /> Refri eration f=loor drain <br /> UVoodstove Grease trap <br /> Ductin Roof droirts <br /> Other [ t G r ilMedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and exemingd this application and know the eame to be true and correct.All provisions of laws and ordinencee govemin9 this type of cork Wit be comp <br /> ;W'Ehethcr specified hereln or not,Trle granting of a permit doee nut presume to glue authority to violate or cancel the provi*ion of any other state orlocal law reguiiErg construction <br /> vi <br /> m authorized by the own r of this property to perform the work for which a lication is made snd I comply with the Slate Contrach',rs Law 10,27 RCW and 29P.200A WAC. <br /> rrAuthortzed Agent Signature Date <br /> 4V( v ed 9/2014) <br />