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9ERMIT APPLICATI00 <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: PROPERTY TAX# RMIT# <br /> \6� `\S� �C S O+-0 2— <br /> LEGAL <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ��.� c��o��rti�a�! �— Phone/E-mail �0.Vl,y�S�`J2� b' c C <br /> Address U�� �� S City/State/Zip k e reeA' <br /> APPLICANT:_IeeFC✓ner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR tom.(— State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/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: T Single Family _Duplex_Townhouse _Multi-Family ,_Commercial <br /> Type of project: _New _Addition Remodel _Repair_T.1._Sign_Sprinkler 1-ilemolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <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 i Toilet <br /> Forced air systems i Bathtub <br /> Gas piping 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 j Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> j Boiler j Drinking Fountain <br /> Refrigeration Floor drain <br /> j Woodstove 1 Grease trap <br /> i Ducting j Roof drains <br /> I 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 authorized by the owner of this property to perform the gLWbklh 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 4/2015) <br />