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PERNIF A PPUC ATMN <br /> 8U�L®ANGIMECHANBCAL/PLUMENOS/ GN/SPMNKLERMEMOLMON <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: <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PROPERTY TAX# P MIT <br /> 0 24 <br /> LEGAL for new construction: Short PlaUsubdivisiondd- 7?'d 61 Lot No. %/ (attach copy of long legal description) <br /> OWNER <br /> Phone/E-mail 201L —2 2-Z--/C l <br /> Address g j 6,qal' d <br /> tJ`G City/State/Zip <br /> APPLICANT:_O;vr,er _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provides leper of consent from the mvner to dowork in the space) <br /> CONTRACTOR /� -'�,c}�- �' 905 Ii(J, i'!lG L& I Lic.# t✓� 5 /�'Ql� <br /> (� E Bus. Lic.# <br /> Address L& C! fYo6M is 1?-914516 <br /> f� q6 Phone/Email iII <br /> TENANT BUSINESS NAME 3 � � 7 7 <br /> CONTACT FOR PERMIT <br /> e )=a7,0-)nS t49c7 R I% <br /> Phone/E-mail r_ '1 �1�SLE ^' �' Ts`"' <br /> SUILDING PERMIT APPLECATION CONTRACT PRICE OF WORK • ;Z&,�''615�-- <br /> Existing Use of Building i2 cc ---E <br /> HEAT SOURCE: <br /> Proposed Use of Building &�-��q Gas_ Electric_ Other !/f <br /> 14 <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I. Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> /nw <br /> i MECHANICAL PERMIT APPLICAT ON PLUM1131ING PERMIT APPLICATO®N � <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 IToilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory <br /> Water heater (wash basin) <br /> � Gas fireplace Shower <br /> Kitchen sink&disposal <br /> Gas range <br /> Dishwasher <br /> Clothes dryer <br /> Clothes washer <br /> Range hood I Water heater <br /> I Exhaust fan <br /> j I Sink(service/bar/mop/etc.) <br /> Heat pump <br /> j reventer <br /> Unit heater Backflow p <br /> Urinal <br /> I Boiler Drinking Fountain <br /> I Refrigeration <br /> Woodstove I Floor drain <br /> Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM !I <br /> 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 authorized by he 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 /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />