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9ERMIT APPLICATI09 <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: PROPERTY TAX# RMIT <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER L I H c� G �` Phone/E-mail <br /> Address SCSI City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent e/5ontractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR / f/ State Lic.# 4�110k"�-q / 6C z,N? L'Ity Bus. Licc..# <br /> Address Phone/Email �-t"Z.5— <br /> TENANT BUSINESS NAME <br /> CONTACT FOR PERMIT <br /> Phone/E-mail 0�, iir /G i^/, C- cis--% <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK L <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Byilding 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 iToilet <br /> Forced air systems i 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 aut orized by the owner 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 /> 0�� <br /> Owner/A:ijthorizffAgent Signature Date (Revised 4/2015) <br />