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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: �� ^ `1/J�� ' /� JPROI�rjy�00O j PER I(#­�q <br /> LEGAL for new construction: Shortt Plat/subdivision G Lot No. (attach copy of long legal description) <br /> OWNER ` ` m d Phone/E-mail Ll-5---mJ — _lvn6 V �YII►t �, 1 <br /> Addressl V ��� 11 ' City/State/Zip C..�Y � ' R li $yl3 <br /> APPLICANT:_Owner�—Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR V L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail �� 4q G v <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building �_ f'"pt\' HEAT SOURCE: <br /> Proposed Use of By ding ^Gas_ Electric_ Other V Imo' <br /> Building type: _Single Famiill _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New V 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 Project: _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 /> I Gas piping Lavatory(wash basin) <br /> Water heater ; Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range t Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> j Unit heater I Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting j Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads j 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 whet er 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 uthorized by the ow of this roperty 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 /> �ov Y/01 1� <br /> /�011i L <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />