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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY O� EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-$857 www.everettwa.org <br /> SITE ADDRESS: �� � PROPERTY TAX li PE�IT# <br /> � � <br /> LEGAL for new construction; Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER �R�:d ry1e c��� PhonelE-mail Z _ — _ (� <br /> Address Zp _ , � CitylState/Zip �V r W 20 <br /> APPLICANT:_Owner ,Owner's Agent �Contractor i Contractor's Agent _Tenant cm�st pro�we e�ener or oonsem rrom me owner�o ao worx�r,u,e sPace> <br /> CONTRACTOR S� State Lic.# $ City Bus. Lic.# <br /> Address p .� � a PhonelEmall Zr—� z <br /> TENANT BUSINESS N CONTACT FOR PERMIT <br /> CI O PhonelE-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 /> T e of ro'ect: New Addition Remodei Re air T.1. �Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> �n��I �'� �� ��'� �� �1� �OTI - �-fvYT�r�� <br /> �/ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_,Addn _Aheration_Repair Type of ProJect: _Naw_Addn ,Alteretlon_Repalr <br /> Show Alumber # of fixtures Show Number # of ftxtu�es <br /> A/C—air handlin units ' Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> ' Gas fire lace Kitchen sink&dis osal <br /> Gas ran e i Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medicai Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby ceRrfy that 1 have read end exami�ed this application and knqw the same to be true and correct.All provisions of laws and ordinances governing this rype of work wiR be comp <br /> with whether specified herein or noi.The granting of a permft daes not presume to give authorKy to violate or cancel the provision of any other state or local law regulating canstruction <br /> That I am authorized by the owner of this property to pertorm the work for which appNcBlion is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC, r/ <br /> -.�---�/ ,I� <br /> <�� � -�o -o�--- <br /> Owner/Authorized A t$1 nature Date (Revised 9/2014) <br />