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• • <br /> P ERWOT AG°PUCATON <br /> BUIL®ING/M ECHANICAL/PLUMM NG/SM/SPRINKLER/DEMOU`ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: <br /> 1. PROPERTY TAX# PERMIT <br /> A/. .s�' <br /> 1.LEGAL for new construction: Short Plattsubdivision /�� e j tot No. <br /> (attach copy of long legal description) <br /> rA <br /> WNER vl j " � � Phone/E-mail �o6 <br /> dress /� '�tl fi) <br /> ��U r City/StatelZip <br /> PLICANT:_Ov✓ner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from lhe owner to do vvork in the space) <br /> CONTRACTOR / , G S �©QQ . <br /> �� U✓i Q !?1S L&GII Lic.# lr E Bus. Lic.# <br /> Address r lQ �/ � G f�`011Gj��� f / C'�ovoj�C� Phone/Email ;UR <br /> ;E:TENANT BUSINESS NAME /� CONTACT FOR PERMITPhone/E-mail �t�UBL®ING PERMI Y APPLICATI®6� CONTRACT PRICE OFWORK-ExistingUseofBuilding_ t°� i2�c� HEAT SProposed Use of BuildingGasElectr /44 <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 /> MECHANICAL PERMIT APPLICATIOM PLUMBING PERMIT APPLICATO <br /> FP.- <br /> 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 <br /> Toilet <br /> I Forced air systems Bathtub <br /> Gas piping Lavato <br /> Water heater ry(wash basin) <br /> � Gas fireplace � Shower <br /> j Gas range Kitchen sink&disposal <br /> Clothes dryer Dishwasher <br /> Range hood Clothes washer <br /> Exhaust fan Water heater <br /> Heat pump I Sink(service/bar/mop/etc.) <br /> Unit heater 1 Backflow preventer <br /> � Boiler I Urinal <br /> Refrigeration Drinking Fountain <br /> Woodstove � Floor drain <br /> Ducting Grease trap <br /> 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 ofwork 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 stale or local law regulating construction <br /> That I am authorized bylhe owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />