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OPPEERNT PPLICAT101 <br /> BUILDING/MEC HANA CALIPLUMBING/SIGNISPRI6 KLERIDEMOLI TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St—Evorett, WA 9$201 425-257-8810 FAX 425-257-8857 www.eve!rettwa.org <br /> SITE ADDRESS: PROPERTY TAX# ERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attachcopy of long legal description) <br /> OWNER(t� Phone/E-mail 4,w- -li - 1 -1 is`�) <br /> L I r) 1LV= City/State/Zip t:E: ' <br /> Address <br /> �'�c3 "11L�'o—�=- <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent —Tenant(must provide a letter of consent from:he owner loop work In thespace) <br /> CONTRACTOR State Lic.# �� Bus. 1-1c.c#6`, I+5� <br /> Address A('�A0 TLe 1�(- <br /> -�� -f-) -6:-1 1 y1C VIC,, ` �1.k� Phone/Email 3(��-� ���- �S a <br /> CONTAQT FOR PERMIT <br /> Phone/E-mail <br /> r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use 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_Spdnkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on1the back): <br /> JK <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 /> Backflow preventer(inside bldg) <br /> Heat pump <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 I Other: <br /> I hereby certify that I have read and examined this application and know the same io be true and correct All provisions of laws and ordinances governing this type of work will be complied <br /> with W spec' in not, a 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 /> aM aut rued b er t s roperty to perform the Work for ch app'cation is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ` D le (Revised 4/2015) <br /> Owne Authorized Agent Si ture <br />