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• • <br /> PERMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: / PROPERTY TAX# PERMIT# 05 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER . antPhone/E-mail <br /> Address ���� City/State/Zip d 2 <br /> APPLICANT:kOwner _Owner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do wont in the space) <br /> CONTRACTOR L& I Lic.# COE 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 Buildinglc_ � +/..� �- HEAT SOURCE: <br /> Proposed Use of Building l 1/C' ,t_et Gas_ Electric � Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> ti <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 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 Toilet <br /> Forced air systems 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 /> Ralyge hood Water heater <br /> Exha st fan Sink(service/bar/mop/etc.) <br /> Heat pUTp Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration 'Floor drain <br /> Woodstove Gft ase trap <br /> Ducting Roo drains <br /> Other MedicaVGas <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 g ranting of a permit does not presume to give authority to violate or cancel the provision o f any other state or local law regulating construction <br /> That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors L aw 18.27 RCW and 296.200A WAC. <br /> n r• <br /> Owner/Authoriz d Agent Signature > 2 Date (Revised 612012). <br />