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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.everettwa.org <br /> SITE DD ES �? F J ;l� PROPERTY TAX# PI F <br /> -2:3; -)/ Ski ` —OQ <br /> / J <br /> LEGAL for new construct n: Short Plat/subdivision / !i ,/ Lot No.-I.R (attach copy of long legal description) <br /> OWNER i Phone/E-mail 7-26� 3 9 .3&,Sk <br /> Address City/State/ ip J <br /> APPLICANT: Owner Owner's Agent &Contractor _Contractor's Agent enant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR c State Lic.# ity Bus. Lic.!21z) <br /> Addres r _ /�/C �L) Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> CaryPhone/E-mail � 2 —Jc s5— <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 35C01,10 <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 e air T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 4 <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 airs stems 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 <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 have r d 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 comp <br /> with wh er spe ified h ei or not.T granting of a permit does not presume to,give aut rity to violate or cancel the provision of any other state or local law regulating construction <br /> That I m author y e wn of grope ty t erfo m the work for which a plication s made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owne rized 4gent Signature Da (Revised 9/2014) <br />