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0 0 <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: %77 A `I/"� �/7/L PDC✓RTMTAX#iq.: 7e-eq 66 G PER c)6 II Ll I I �`r <br /> LEGAL for new constriction: Short Plat/subdivision Lot No. (attach copy of long legal description) (J 7 <br /> OWNERZ7�/ ;T 17 Al//�/,,- Phone/E-mail0,�--7 Z7 <br /> Address 17-7e5, iF - 3 City/State/Zip <br /> APPLICANT: I,-.'Owner _Ownefs Agent _Contractor _Contractor's Agent _Tenant(mustprovide aletter of consentfrom the owner to do work in the space) <br /> CONTRACTOR State Lic.# City Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT/e)/V IV <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 1 f-k HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric V Other <br /> Building type: _Single Family _Duplex Townhouse Multi-Family Commercial <br /> Type of project: New _Addition _Remodel V 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 /> Forced airs stems _ Bathtub <br /> Gas piping Lavatory wash basin <br /> _ Water heater Shower <br /> Gas fire lace _ Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryerClothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refricleration 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 comp) <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 /> Thatrau d by4hE owner of this property to perform the work for whichapplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,z �/0 <br /> ��. <br /> OwnerlAut red Agent Signature Date (Revised 9/2014) <br />