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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 />r Anr Fotcn FROM A AM Tn A PM <br />SITE 9D S' �' PROPERTY TAX 1 isP TS W -OZ <br />/ ( <br />LEGAL for new construction: Short Plat/641rdivision Lot No _ (attach copy of long legal description) <br />- - <br />OWNER Phone/E-mail <br />Address %C <br />CIIylSlaie/lip <br />APPLICANT:_Owner _Ovmers Agent Contractor Contractor's Agent _Tenant lmusl lvav,danienwumnsanthom aw oeaermtlo xok^mo sparal <br />�- L & I # coyTA COE Bus. Lic. # <br />CONTRACTOR ' <br />{Laic. <br />U - / Phone/Email y.� -p) `- <br />Address ,� ( f ) p <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phonon'.mad j 7 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building - <br />Proposed Use if Building Gas_ Electric Other <br />Building type: Family _ Duplex _Townhouse _ Muili-Family _ Commercial <br />,..Single <br />Type of project New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chan a of Use <br />DESCRIPTION OF WORK (additional space pmwded on the back): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now _Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteratlon _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavato (wash basin) <br />Water heater <br />Shower <br />Kitchen sink & disposal <br />Gas hr?place <br />Gasran a <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Ran a hood <br />Water heater <br />Exhaust fan <br />Sink (servicelbarfmoplev; I <br />Heat pump <br />BackFlow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Duchn I <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />Other. <br />I hereby cendy that I have read and eaaril this application and know the same to be true and comets All provisions of laws and ordinances governing this type of work will be complied <br />wnh whether speared herein or not The gmnling of a perme does not presume to give authomy to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the Amer of this prop�d to perform the work for which application is made and I campy with the State contractors Law to 27 RCW and 296 200A WAC <br />�OwnorlAuthorizod Agon��atur '/ le (Revised 6/10 f 2) <br />