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PERMIT APPUCAT <br /> BUaLDI�A GIMECHANICAL/PLLJMBINGISIGNISPRINKLER/DEMOLQTION <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• PROPERTYTAX# PERMIT# <br /> Z91 6 L9 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER r" Phone/E-mail 'f -210-3917 <br /> Address City/State/zip <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consanlfrom the owner to dp work in the space) <br /> CONTRACTOR iState Lic,# 11Et C?92-C-1-C City Bus. Lic.# 00-7`9 <br /> Address 2-V2,0 lNGIrLC_ k)e. V=� 5 l . I ld� I PhonelEmail <br /> TEIQANT BUSINESS NAM CONTACT FOR PERMIT <br /> � f-O <br /> �✓�!, i.`:� h '.4:if.C Ph�on E-m Il"•��"I �S'Z 2' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORT( Z Qt SO0 <br /> Existing Use of Building 0 t- HEAT SOURCE: <br /> Proposed Use of Building N O C 1r Gas_ Electric K Other_ <br /> Building type: Single Family ._Duplex Townhouse _Multi-Family --L Commercial <br /> Type of project: —New _Addition _Remodel k Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on th ack): <br /> PAT- <br /> MECHANICAL <br /> PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration j--Repair Type of Project: _New_Addn ,_,Alteration_Repair <br /> Show Number(##)of fixtures Show Number(##)of fixtures <br /> 1 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 Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater llrinal - <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting J 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 compiled <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 rized 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. <br /> owner/Authorized A&tSignature Date (Revised 4/2015) <br />