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PERMIT APPLICAT <br /> B UILDI NG/M EC HAN ICALIP LUM BIND/SIGN/SPRINKLE MENIOLIT10N <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: RnPROPERTYTAX# MIT# <br /> 1 n <br /> 9-P 5 co ca l <br /> LEGAL for new construction; Short Platlsuhdivision1 n�T r rJ Lot No.� (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address I City/State/Zip <br /> APPLICANT:_Owner —Owner's Agent _Contractor _Contractor's Agent —Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR S�C 7�,/�L State Lie.# c-)J✓Ve-e- City Bus. Lie,# <br /> Address -7 Phone/Email <br /> k': C� CJ�;'if S �-� / <br /> TENANT BUSINESS NAME `/� CONTACT FOR PERMIT l �1 <br /> I"�� r W'�77 Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ) <br /> Existing Use of Building P-,'e- HEAT SOURCE: <br /> Proposed Use of Building ��- Zt ( Gases Electriq� Other <br /> Building type: _Single Family _Duplex_.Townhouse _Multi-Family ,�L Commercial <br /> Type of projec _ _ ddition Remodel Repair_T.I._Sign_Sprinkler_DemolitionPESC _Change of Use <br /> IPTION OF WORK(addition ace provided on the back): / <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _�j New_Addn ,_,Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 5eToilet <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 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 /> I Ducting I 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 <br /> That I am authorized by the owner of this property to perfo the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Date (Revised 4/2095) <br /> owner/Authorized Agent Signature <br /> 1 <br />