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*PERMIT APPLICATOR <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 /> R <br /> SITE ADDRESS: ,2 � r PRtO�PE,R�� f "J�/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. `T (attach copy of long legaldescription) <br /> OWNER' / Phone/E-mail <br /> Address —[`"r w City/State/Zip — <br /> APPLICANT:_Owner -x Owner's Agent _Contractor _Contractor's Agent _6Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> j <br /> CONTRACTOR �,t.1r' State Lic.# �wQ 1)(}4eMLCity Bus. Lic.# <br /> Address l AL1 � �` _ Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> /- 2-G z),2 4-1 <br /> Phone/E-mail A.W (, .- <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 _Remodel _Repair X T.I._Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> V <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&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 /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I ve rPne <br /> xamined thiIto <br /> pplication a d 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 afied here .The grantingf a permit d s not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I a thorizedyytf this pr e perform th work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owne/A orized Ag ri Signet Date (Revised 4/2015) <br /> ,�Z <br />