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*PERMIT APPLICATIA <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: A /�J` i PROPERTY TAXtt P�{F�T D r 2 <br /> 3426 �- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER t 4�'J, Phone/E-mail <br /> Address 3 ��' oHtie �uB City/State/Zip <br /> APPLICANT:A/Owner _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 her State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> c., ,O�11t!k,-1,, ►'�fo� <br /> Phone/E-mail 4aL 6—330— ?0 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK TOM, <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building type:- Ingle Family _Duplex_Townhouse _Multi-Family ,_Commercial <br /> Type of project: _New _Additio model _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 Alteratio _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 /> SPRINKLER / SUPPRESSION 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 gtAhorized <br /> �byy the owner of IN property 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 /> C. S <br /> Owe Auth ized Agent Signature Date (Revised 4/2015) <br />