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i • <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 ADDRESS: PROPERTY TAX# ERISA T# <br /> e t t ti €� c _ L: c <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <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 State Lic.# 459i,A)U City Bus. Lic.# <br /> Address �y 1.` �U� �� (i 4-, lCL4, Phone/Email <br /> TENANT BUSINESS NAME 1 CONTACT FOR PERMIT <br /> Phone/E-mail -i2 - 'Zl�i74t✓bv&,*0c]O`� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building r (v�``1ry / F� �> 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_Sprinkler „4-Demolition—Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> u�f' �f @�i✓YL U'� {�� f�v� �Y`�Ut'• Citi�yV�Y”' 'e� �C>Y lU u� <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 i Lavatory(wash basin) <br /> i Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range j Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> j Heat pump Backflow preventer <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> 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 authorized 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 /> Ow /Authorized A nt Signature Date (Revised 3/2013) <br />