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• <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 PROPERTY TAX# P R ( 30!T# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 6r EJ .E-TJ- t[,, Phone/E-mail �-4 Z15 "3185^`119 8 <br /> Address 37 !� psl.eS 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 W JIG AA4G DffMV T tate Lic.#(, 9&LV,ed 24WO City Bus. Lic.#033-P <br /> Address 3310 ,x+ " Phone/Email <br /> TENAN <br /> T BUSINESS NAME / CONTACT FOR PERMIT <br /> 8 4 4defCelle./' J-ro�tS� Phone/E mail 1&h S 0 � $W B� t�Qt' �coM <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_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> [��,n/� Mous-,? ZZ� <br /> � <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 j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace ! Kitchen sink&disposal <br /> j Gas range Dishwasher <br /> _ Clothes dryer i Clothes 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 /> 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 /> WW (`,q1201dJ41- f-2o- ,1.3 <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />