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425-252-1666 c.m. heating 12:03:14 11-06-2015 4/4 <br /> 10 <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: ` Q[���G(� fes+ PROPERTY TAX t# P,1 <br /> MI - <br /> 1 li 1/11 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER l �7(✓rteQ/� <br /> Phoney/E-malt � O�U�.J <br /> Address <br /> City/State/Zip <br /> q Sa <br /> APPLICANT:—Owner _Owner's Agent —,/—Contractor —Contractors Agent _Tenant(must provida a latter of consent from We ownerto do work In the space) <br /> CONTRACTOR t C n )vic, State Lic.#C — y Bus. Lic,# 01 "1 <br /> Address l if f bznC4Kai I V N q xza l Phone/Email(4 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Z�� <br /> �e12 LL' <br /> PhonelE-mall Ir n <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK , DQ .-- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Bt}tttlIng Gas Electric Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _Now_Addn _Alteration_,Repair Type of Project: _Now_Addn _Alteration Repalr <br /> Show Number(#)of fixtures Show Number fE of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems 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/me lett. <br /> Heat um Backflow preventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> DuctInq Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that 1 have read and examined this applicatIon and know the same to he true and coned.Ail provisions of laws and ordinances governing this type of work will he cornpl <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 focal law regulating construction <br /> That I am authorized by the owner of this prope o performthe work far which application Is made and I comply with the State Contractors Law 10.27 RCW and 296.200A WAC. <br /> C <br /> E5 p _. _ <br /> OwnerJAuthorf d A - <br /> gent Signature Date <br /> � (Revised 9!1014) <br />