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• <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: -3) ~— PROPERTY TAX ti <br /> pERMIT ti <br /> 0 5 os, Cb3 q U‘q-'0O300 Cl( In()\ LQD — 01-0 <br /> LEGAL for new construction; Short Piet/subdivision Lot No, (attach copy of long legal description) <br /> OWNER :., -( 4. Phone/E-mail , ,5 • i 6 - a <br /> Address City/State/Zip <br /> APPLICANT;_owner _owners Agent 4Cantractor Contractor's Agent <br /> 9 t _Tenant(met provide a weer di consent from the owner to do WOfk in thenp.cq) <br /> CONTRACTOR L 4 _ t�. L! State Lic. jy�, ,`,t�►aQ -) City gnp` <br /> us. Lie.# of g 0 <br /> Address pts - 110 L 1.4_ 0 8 I V8 PhonetEmail " g • <br /> TENA T BUSINE S NAME CONTACT FOR PERMIT p�Dkp .a Ob <br /> ' <br /> Phone/E-mail rn•1-t,(Dbr kuji yk4 . C,OVV-1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ( _ <br /> Existing Use of Building . <br /> . r HEAT SOURCE: <br /> Proposed Use of Build no Gas �ectric Other <br /> Building type: ✓Single Family —Duplex Townhouse —Multi-Family Commercial <br /> Type of project: New Addition Remodel Re air 4–.0,1, Sin Sprinkler Demolition Change f Use <br /> DES RI TION OF WOR additional space provided on the back)! <br /> 11 1 ` <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 xtures Show Number(#1 of fixtures <br /> r NC–airng units j Toilet <br /> Forced airustems 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 Sink(service/bar/mop/etc) <br /> Heat pump Backflow preventer <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 <br /> 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 end correct.All provisions of Tawe and ordinances governing this type of work will be comp <br /> 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 rcguietjng construction <br /> I am authorized by the own•r of this property to perform the work for w lch apOlicat an is made and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC, <br /> . • * <br /> �-- ) LI hate (Revised• criAuth•mad Agent Signature ^Date (Revised 9/2014) <br />