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10 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: PROPERTY TAX# PERMIT# — <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> t 'dC49 VA <br /> Phone/E-mail ( L3 c t v C <br /> OWNER r� - .moi ' -12-3 r C � <br /> Address F���7— 7J� i City/State/Zip /= F/lc- p°— Lt-JA- <br /> APPLICANT: <br /> n APPLICANT:tf'Owner _O�wrner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR — � '1 a � { ;J� q V State Lic.# City Bus. Lic.# <br /> A�res� Phone/Email �-y=�^-'4�B7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <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 projec� New Addition Remodel Repair_T.I._Sign_Sprinkler 4Demolition_Change of Use <br /> DESCRIPTION OF WORK(addi�ti)onall spa rov'ded 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 /> I Forced air systems j Bathtub <br /> j Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> j Exhaust fan Sink(service/bar/mop/etc.) <br /> j Heat pump Backflow preventer <br /> Unit heater j Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove ! Grease trap <br /> 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 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'tp perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Argent Si nature Date (Revised 3/2013) <br />