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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# P R # <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ~ �(� Phone/E-mail2,S2– <br /> Address Z�D .� City/State/Zip <br /> APPLICANT:—Owner _Owner's Agent _Contractor Contractors Agent Tenant(must provide a letter of wnsent from the owner to do work in the space) <br /> CONTRACTOR tate Lic.# <br /> 'fjCo1M.g. City Bus. Lic.#– <br /> Addressdozo � �� �3� ( C)Soll Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> -I-Er-'f a4LLILA l,,p, <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK zptostp <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Sof` Gas Electric Other <br /> Building type:X-Single Family _Duplex—Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel X Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> F1a 'PA �, -16 Wce>D- iZpC#4tV(&C�9<5A;FZ4— ��. <br /> r ST,r." <br /> MECHANI AL 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 j Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin <br /> I Water heater I Shower <br /> { Gas fireplace i 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 /> i Unit heater Urinal <br /> Boiler Drinkinq Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I <br /> Ducting Roof drains <br /> Other_ Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> i 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 compj <br /> with ether specified herein 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 m aut rized ner of ttij5.prepeTty 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 /> W85- fi/,.?- <br /> O u Agent Signature S I Date <br /> (Revised 9/2014) <br />