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4PERMIT APPLICATI00 <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 ADDRESS: 30 <br /> I � �VI�J PROPERTY TAX P MI <br /> y 2- -f) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of lon'gg legal description) <br /> OWNER ��R� NDF— — }S 000 Phone/E-mail -G63- 266- UU 28 <br /> Address �j� — ��U I 5 tj City/State/Zip 416th t l k:8-� <br /> APPLICANT: IZ,0 wner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 6) W/v State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building S'fy fe��X� HEAT SOURCE: <br /> Proposed Use of Building 1��� Gas_ Electric_ Other <br /> Building type: V 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: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> I A/C–air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory (wash basin) <br /> Water heater Shower <br /> j Gas fireplace Kitchen sink&disposal <br /> I Gas range Dishwasher <br /> j Clothes dryer Clothes washer <br /> Range hood Water heater <br /> i Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other i 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 by the owner of this pr perty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC./ <br /> 'g�V� <br /> Owner/Authorize Agent ignat re Date (Revised 3/2013) <br />