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4PERMIT APPLICATI09 <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: 5 _ PROPERTY TAX# PE MIT <br /> Z �j C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legaldescription) <br /> OWNER ��ti� //'�J�1 ^/y�� t Phone/E-mail /7 c� <br /> Address,l� "- V�/-1�/�tJ City/State/Zip <br /> APPLICANT: caner _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 r State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail II <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ! •�� <br /> Existing Use of Building /J HEAT SOURCE: <br /> Proposed Use of Building Gas_ Efec Other <br /> Building type: ngle Fam'y _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 sae provided on th ack)' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New dy Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units 2 Toilet <br /> Forced air systems Bathtub <br /> Gas piping = Lavatory(wash basin) <br /> I Water heater Shower <br /> j Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> j Woodstove Grease trap <br /> i Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> iNumber 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 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 Dat Z71 (Revised 3/2013) <br /> —4Z <br />