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Nov 21 2013 2: 34PM RDFIMSPLUMBING 3GO-G91 - 1382 p . 2 <br /> 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: Un ® F <br /> OPERRTYTAX# V PE 1IT9, ,(5,02. <br /> LEGAL for new construction: Short Plat/subdivision �v Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address . Vv 1 City/State/Zip t\" IWI\ <br /> APPLICANT: —Owner Owner's Agent –Y—/ Contractor _Contractor's Agent ___.Tenant(must provide a letter of consent from the owner to do work in I"apace) <br /> CONTRACTOR NUAM1910A L & I LIC. # AD&M32F11 I lb 03 COE Bus. Lic.# 2 6 <br /> Address ) x Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �7 � <br /> i m 1oV k l POImo'i ` M i <br /> Phone/E-mailer <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK l9"1 40 <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 /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Now_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(servicelbarlmopletc) <br /> Heat pump Backflow prevenfer <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 I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereoy certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances goveming thda 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 by the owner of this properly to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> Owner/Authorlead Agent Sienature Date (Revised 612012) <br />