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PERMIT APPLICATIUN <br /> BUIL®ING/MEC HANICAL/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 /> PROPERTYTAX# P(Jr;/) 0,% <br /> SITE ADDRESS: (vn <br /> /,�- VP-r <br /> LEGAL for new construction: hort Platlsubdivislon Lot No. (attach copy of ibng legal description) <br /> OWNER ZLC Phone/E-mail <br /> Address �� , ltf X/o� City/State/Zip <br /> APPLICANT:—Owner _Owner's Agent _Contractor _Contractor's Agent —Tenant(must provide a letter of consenl from the owner to dp work In the space) <br /> CONTRACTOR 2rf State Lic,# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail �r� 0 <br /> BUILD114113 PERMIT APPLICATION CONTRACT PRICE OF WORK % <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 1patltd <br /> Gas_ Electric Other <br /> Building type: ^Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _ Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): ,,cc <br /> 9 <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 /> 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 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 perform the work for which <br /> application is made and I�comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (Revised 4/2015) <br /> Owner/Authorized Agent Signature Date <br /> 1, �� <br />