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PERMIT APPLICATION <br /> BUILDING/M ECHANICAL/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 /> SITE ADDRESS: PROPERTY TAX# P RMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 7— h Phone/E-mail <br /> Address (7/ 11�,/of tt, City/State/Zip <br /> APPLICANT:—Owner _Owner's Agent KConfractor —Contractor's Agent _Tenant(must provide a letter of <br /> consent from the owner to do work in the space) <br /> CONTRACTOR V"TkALA-kW State Lic.# , City Bus. <br /> Address L�O �)©(rh O RT Phone/Email �eve,r Levcum <br /> CONTACT FOR PERMIT <br /> N P 0 SUP 4 <br /> - ` Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C),0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 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): <br /> I Ird4r iJ v� bm rte + , a r Z(-��' <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 sa p cified herein o�t.The granting of 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 or ed by the w r of this prop y t perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> i <br /> <i <br /> Owner/Authorized Ag nt Signature Date (Revised 4/2015) <br />