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• • <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 /> SITE ADDF3 JSS: PROPERTY TAX# P MIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of�2long legal description) <br /> OWNER ` �,1 l� r Phone/E-mail 2 , <br /> Address �? �.- J.,r.�✓� - /� City/State/Zip 1 <br /> APPLICANT:—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 n State Lic.# �-�V J City Bus. Lic.# <br /> 1712 <br /> Address SZ. 8 4+n r —SZ. Phone/Email '� S 1 L I ' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 7 9%1 <br /> Existing Use of Building HEAT SOURCE: <br /> Propose se 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: _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 /> I Forced air systems j Bathtub <br /> j Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range I Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood j Water heater <br /> i Exhaust fan j Sink(service/bar/mop/etc.) <br /> j Heat pump I Backflow preventer <br /> j Unit heater j Urinal <br /> Boiler Drinking Fountain <br /> j Refrigeration j Floor drain <br /> Woodstove j Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I 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 herei 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 lam authorized by the wner of this 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 /> Ow /Authorized A ent Sign re Date (Revised 3/2013) <br />