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OPERPUT A PPL IC °;TON <br /> CBUIL®INO/MECHANICAL/PLUMBING/SIGNISPRi�AKLER/DEMOLTIOGA <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereftwa.org <br /> DDRESS: <br /> PROPERTY TAX# PERMIT# <br /> SITE A <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Phone/E-mail :. 11 <br /> OWNER 1�i;f1,.� A Ff-ro a _ <br /> Address z f�,�t 14v City/State/Zip <br /> R¢ <br /> APPLICANT: J�Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR State Lic,# City Bus. Lic.# <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Se.4tL Gas X 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): o�cl Gu7A d- ­A !U=`"' 6-Y W!, <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 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(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 /> SPRIIR KLER / SUPPRIEssiom sYsTEm 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 by the owner of this property 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 /> riq//5�1y <br /> Ow u onzed nt Signature Date (Revised 4/2015) <br /> v <br />