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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 /> • DW,7/07i30 (c l be -iC5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Z6 d , 2 ?#S? Phone/E-mail - 0:519" g. /Capit �ilat 'p <br /> Address C.�? 4fit tel/ 6T City/State/Zip , '11Arra. fleoW <br /> APPLICANT: Owner _Owner's Agent --Cantractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> y <br /> CONTRACTOR eweli t. Sip✓..r4✓ 4, State Lic.# 4✓f 4C 08?6'iG City Bus, Lic.# C '3 2770' <br /> Address - , A Phone/Email # c- <br /> z s y Y� <br /> • • r <br /> CO <br /> -ACT F02jE9f <br /> i2 'Fr- ,< i4 Phone = 0C-d1 <br /> O <br /> `,KSY/ yt.ICY/! /1* (2;1'1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (,::'C ) • n.o <br /> Existing Use of Building £ .Wc ' - A HEAT SOURCE: <br /> • <br /> Proposed Use of Building .. 9s "Z Gas Electric Other <br /> Building type: Single Family Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: New Addition Remodel _Repair T.I._Sign 14prinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space pr vided on the ba ):/� <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 Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan i Sink(service/bar/mop/etc.) <br /> Heat pump ( Backflow preventer(inside bldg) <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/-pecified he 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 a/ orized b h 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 /> Ow uthorized Agent Signature Date (Revised 4/2015) <br />