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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/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 q PERMIT <br /> � l.�t�(,1� 1 � — � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ,JQ [� Phone/E-mail � � • i,�l.� 0 T � Z/ �-l�Lf`i�ll,�OYIA <br /> Address `/�� CitylState/Zip �(/ , R L(j <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor'S A90flt _TBilBfll(must provide a letle�of consenl from lhe owner lo do worK in the space) <br /> CONTRACTOR /�'�' State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �'� Phone/E-mail ���^'�' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK��� <br /> Existing Use of Building (i�Cr..��j,C� �0'�� 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 /> l�i,�,l d-��p �,c,w,o�c�',�� <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 /> j Forced air systems � Bathtub <br /> � Gas piping j Lavatory(wash basin) <br /> ; Water heater ; Shower <br /> Gas fireplace ; Kitchen sink&disposal <br /> j Gas range i Dishwasher <br /> ; Clothes dryer 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 j Floor drain <br /> Woodstove Grease trap • <br /> Ducting Roof drains <br /> j 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 lype 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 /> �— � "/ 1 <br /> Owner/Authorize Agent Signature ate (Revised 3/2013) <br />