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i r <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 ADDR SS: 1 } 79136 <br /> 2 PROPERTY TAX# PE MIT# 0� G S <br /> W <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip )Q LA lNr!`• O�C�� <br /> APPLICANT:_Owner _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.#��0.Yuen O ,� City Bus. Lic.#� <br /> Address/89,33 �J� �o�Q_/7�� `�'IaA", /�g I Phone/Emai]246 <br /> TENANT BUSINESS NAME U CONTACT FOR PERMIT <br /> Phone/E-mail 0 3 55" 3.5 36 <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 74 Commercial <br /> Type of project: New Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provf ed on the back): I <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 i Toilet <br /> Forced air systems Bathtub <br /> cp 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 /> j Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> Ducting e Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM 7 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 complied <br /> with whether specked 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 /> S �o y <br /> OwnerlAuthorizi,01 Agent Signature Date (Revised 3/2013) <br />