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PERMIT APPUCATO-N <br /> BUILDING/MECHANICAL/PLUMBINGISION/SPRINKLER/DEMOLQTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 08201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE AD RESS: PROPERTYTAX# �0 .. <br /> PERMIT O <br /> i EaD c c� c�! , <br /> LEGAL for new construction: Short Plat/subdi sion Lot No. (attach copy of Ibng legal description) <br /> OWNERS ? Phone/E-mail <br /> Address City/State/ZIP <br /> APPLICANT:—Owner _Owner's Agent —Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to Op work In the space) <br /> CONTRACTOR &-Zrf4n State Liic.# F-VU 55092-Y City Bus. Lic.# Oo <br /> Address 2k2v Ac-(I!L Aur-- ggZo[ Phone/Email 42-1 2�2 �i <br /> TENANT E3U,91NE,95_NAMF- CONTACT FOR PERMIT <br /> �r✓rtJidl S� C�'vc,r.� jn't �¢'�S�tuiit .�n <br /> Phone/E-mail 3//V <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 0(90 <br /> Existing Use of Building A(P HEAT SOURCE: <br /> Proposed Use of Building® Gas is Electr'c Other <br /> Building type: Single Family _Duplex Townhouse _ Multi-Family K Commercial <br /> Type of project: —New —Addition _Remodel IC Repair—T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): , <br /> gia I -.vc � Lt4 F-TJ 9� C�+�OA��� � wtc�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration3LRepair 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 /> 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 Roof drains <br /> Other Med'Ical Gas <br /> SPRINKLER I SUPPRESSION SYS`ITEINI 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 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. <br /> Owner/Author' gent Signature Date (Revised 4/2075) <br />