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i • <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 /> SITE ADDRESS: PROPERTY TAX# PERMIT <br /> 2428 21 st ST Everett, WA 98201 /(/( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER MaryJane Hacker Phone/E-mail 425-268-6723 <br /> Address same as site City/State/Zip <br /> APPLICANT:_Owner Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Puget Sound Gas Works, LLC state Lic.# PUGETSG851 N6 City Bus. Lic.# 055214 <br /> Address 30326 36TH Ave NW Stanwood, WA 98292 Phone/Email 360-629-6082 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT PugetSoundGasWorks@Gmail.com <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK *0 850 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_K Electric Other <br /> Building type: -Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of ro ect: New X Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Gas line install to gas range outlet <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn XAlteration_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 airs stems 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 Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> DuctingRoof 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 of work will be compl <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 /> 3/11/2016 <br /> Owner/Authorized Agent Sign to a Date (Revised 9/2014) <br />