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0 0 <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: � P OPERTY TAX#NN" U O S-�3 t' D O Cj 0 33 p(� RMIZT-�#�,7, <br /> LEGAL for new construction: Short Plat/subdivision / 1 Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address -7pZ City/State/Zip <br /> APPLICANT: v Uwner _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 L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�,06�, <br /> Phone/E-mail //' 3� <br /> G�yy <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building C V-r t-- HEAT SOURCE: <br /> Proposed Use of Building ��F S/ �� �� Gas_ Electric_ Other_ <br /> Building type: V'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 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 i Shower <br /> Gas fireplace j Kitchen sink&disp al <br /> Gas range Dishwasher Al <br /> Clothes dryer j Clothes washer 7/ <br /> Range hood A) ,tU 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 /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEMV Other: VrIL/1 ,v <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 uthorized by the o er 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 /> 7 <br /> caner/Authoriz Agent Signature Date (Revised 6/2012) <br />