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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 /> i C) Dft—� F'(J gI3C6 -0t <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNERS > �1 v��l Phone/E-mail '2-b(0 — 12 <br /> Address 2JD D1 —k p/ ./ City/State/Zip • ?)303 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR �(}N\cs ( J Z1— �)Q`�U�State Lic.*JON)c-1-- bity Bus. Lic.# <br /> Address pc) 3 OX \ MA-- Phone/Email 4-75--qul - 401 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail r`.l ) S` �L]� — 3-7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ?( 5 <br /> Existing Use of Building tU�N.A l7 HEAT SOURCE:VO <br /> Proposed Use of Building.S LA Gas Electric>( Other <br /> Building type: )(Single Family Duplex Townhouse _Multi-Family Commercial <br /> Type of project: New 7C, Addition __Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration_Repair Type of P jest: _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 j \ Shower <br /> Gas fireplace N Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer C thes washer <br /> Range hood j Wa r heater <br /> Exhaust fan Sink ervice/bar/mop/etc.) <br /> Heat pump Backflo preventer <br /> Unit heater I Urinal <br /> BoilerDrinking F ntain <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 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 I <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. 2 <br /> ,1011140 • .2‘I <br /> Owner/Authorized Age Signature Date (Revised 3/2013) <br />