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02/27/2014 10: 25 2085620555 BUSS h.1ECHANICAL SR'v'C PAGE 01/02 <br /> PERMIT APPLICATION <br /> BUILDING/MEC HANICAL/PLUMBING/SIGNIS PRIN KLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 95201 425-257-8810 FAX 425-257-8857 www.evei-ettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE A DR SS n PROPERTY TAx u PERI,IT# <br /> LEGAL for new construction: Short PlaUsuhdivislon Lot No. (attach copy of long legal description) <br /> OWNER v �, ���n Phone/E-mail <br /> Address city/state/zip <br /> APPLICANT' Owner Owners Agent Cpontractor -11,1/Contractor's Agent Tenant(m.uat p—ide�letter of oon"ntttoni tri own-r to do work in the zprica) <br /> CONTRACTOR I < C.> L& I Lic.# "CSO\ } C/OOE,Bus. Lic. <br /> Address ,�r o y G� Phone/Email <br /> TENANT aUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mall v�v�� UVW�IftCi4iLt`�lWl,. lY�'l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE= <br /> Proposed Use of Building Gas— Electric Othcr _ <br /> Building type= _Single Family _Duplex_Townhouse —Multi-Family _Commercial <br /> Type of ro act: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(6dditionai space provided on the back) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New Addti _Alteration�Repalr <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems I Bathtub <br /> Gas piping Lavatory(wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis oSal <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 preverittr <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 corlify that I have read and examined this application and know the same to ba true and correct.All provisions of laws and ordinances goveming Wis type of work will be complied <br /> with whether speGfied herein or not.The granting of a permit doss not presume to give authority to violate or cancel the provision of any other state or loc81 law regulating construction <br /> That thonzed uy the own his property to p=rior rn the work for which application Is made and I..r-.)Ply with the state Contractor:Law 18.27 RC W and 296.200A WAC. <br /> � v �i <br /> Own er/A prized Agent Si etur Date (Revised 6/2012) <br />