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AN <br /> GSCRMITAPPLICAT <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRIN LER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., .Everett, WA 98201 425-257-8810 FAX 425-257-8857 wvvw.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address `570mow J, ,�� City/State/Zip <br /> APPLICANT: Owner _Owner's Agent "Contractor —contractor's Agent _Tenant(must provide a letter of consent <br /> from the owner loop work In the space) <br /> CONTRACTOR ��<K ✓ State Lie.# !s�/�c:SC7v`LCity Bus. L ic.# �, ) <br /> Address �� ��� Phone/Email19,7W <br /> CONTACT FON61--lo ERMIT <br /> e �.s Phone/E-mail D `T <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: ^Single Family _Duplex—Townhouse _Multi-Family Commercial <br /> Type of project: _New —Addition I�Z—Remodel _Repair—T.I._Sign- Sprinkler_Demoljtion_Chang e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Oro <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 9 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(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certif 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 wheth r 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 a t rized by)t owner of this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> Ow er/A thorized Agent Signature Date (Revised 4/2015) <br /> ��Z <br />