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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <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 DDR�SS: JZMTLecly) <br /> ; J PE11IT# <br /> LEGAL four new construction: Short Plat/subdivision __ _.,__ Lot No. (attach copy of tong legal description) <br /> OWNER y* G� TEPhone/E-mail / <br /> Address City/State/Zip <br /> APPLICANT:v Owner —Owners Agent XContractor —Contractors Agent _Tenant(must provide a letter <br /> yof oonsent from the owner to do work.I the sauce! <br /> CONTRACTOR t,�,�r/t r� SEate Lic.# j K`'T City Bus.t_ic.#C)9 t <br /> Address 01 5 �,S PhonerEmaii r •OQ k4 0117), <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Q.a lYZt t CD L5A-V\A,-Ar'-N <br /> Phone/E-rnail ( m t A-tD <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of B ding Gas L"-— <br /> Electric Other <br /> Building type: T Single Family —Duplex_Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane 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_Adds ;Alteration,_Repair <br /> Show!Number # of fixtures Show Number # of fixtures <br /> A/C-air handling units Toilet <br /> Forced airs stems 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/mo !etc. <br /> Heat Pump Backflow preventer <br /> Unit heater Urinal <br /> i Boiler Drinking Fountain <br /> Refricleration Floor drain <br /> Woodstove Grease tris <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> 1 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 comp <br /> 'h whether specified herein or riot.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 /> Tha 1 am authorized by the own r of this property to perform the wait <br /> ai for whi application is made and I comply with the State Contractors Law 18,27 RGW and 296.200A WAC. <br /> nerlAuthorized 0 <br /> gent Signature Date (Revised 912014) <br />