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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.everettwzi.org <br /> SIT�ADD ES <br /> D �. <br /> 17�rggj# P RMIT# <br /> LEGAL for new construction; Short Plat)-subdivision Lot No. attach eo <br /> ( py of long legal description} <br /> OWNER 1 T i(/Lf t Q— It::) <br /> Phone/E-mail <br /> Address jQX 3 City/StataiZip J O U) 5 <br /> APPLICANT:_Owner Owners Agent _Contractor Contractor's Agent g _Tenant(mut prgvlUg a IetMr of conxnt from the avmgr SO d0 Work in the space) <br /> CONTRACTOR State Lic.# 19n City Sus. Lic.#d a G a <br /> Address 0 ` �� f (✓16 Phone/Email 10 .�l� 8 ---A Qt> <br /> TENAN BUSINES NAME CONTACT FOR PERMIT aAry,I L <br /> Phoney-rriall C-0 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORT( �00 <br /> Existing Use of Building C <br /> HEAT SOURCE: <br /> Proposed Use of Building___ Gas E(sctriqZr Other <br /> Building type: —�4ingle Family _Duplex_Townhouse _Multi-Family —Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign S rinkler Demolition Chane of Use <br /> 1Y\ ®I TION OF WQRE((OaO7 space 0»the ba ): <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 7a�,handljnq units IToilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatorywash basin <br /> Water heater Shower s osa <br /> Gas fireplace Kitchen sink&djl <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust{an Sink setvlcelbar/mo /etc. <br /> Heat purnnip ,(s s Backflow prevanter <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri oration Floor drain <br /> Woodstove Grease tra <br /> Dustin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other <br /> I hereby certify that I have read and examined this application and know the aeme to be true and correct,All provisions of laws and ordinances governing this type otwork will be comp <br /> whether specified herein or not.The granting of a permit does not presume to give euthortty to violate or cancel the provision❑f any othersbte or local law regulating construction <br /> Tha tem author zed by the own r of th�pmp2,Aly to perform�Ih,,work far which pylic tion is made and I comply with the Siete contractors Law 18.77 <br /> RC and 296.200A WAC. <br /> 4 <br /> nerlAuthonzed Agent Signature to (Revised 912714) <br />