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PERMIT APPLICATION <br /> BUILD ING/MECHANICAL/PLUMBING/SINNIS PRINKLERMEMOLITION <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: S w � /n PROPERTY TAXfi P i IT# <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER Phone/E-mail (2!E5)-z4+G <br /> Address -7—C-)Z-1 ��(p - �� "- � City/Siate/Zip /+---k �- <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter or consent from the owner to do work In the space) <br /> CONTRACTOR ��.+ v�, State Lie.#�,4A1,D1fJ '+d-7//FrXity 13u,, Lie.'# <br /> Address 3:* llQ ?®"}/ I Phone/Ema) Grp <br /> TENANT BU51RESSITAW CONTACT FOR PERMIT <br /> Phone/E-mail <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_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRJPTiON OF WORK(additional space provided on the back): , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project. _New_Addn _Alteration Repair Type of Project: _Now_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 /> L 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 /> I Ducting ! Roof drains <br /> Other Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM i 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 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 authorized b e o o.this property to perform the :Z5//5 <br /> ich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> _. <br /> Owner/Atlt rrzed Agent Signature Date (Revised 4/2095) <br />