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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 /> 7 ApDR�SSt � �+ PROPERTY TAX ' PERMI <br /> L 6—in �pb000 oo JU"� D <br /> LEGAL,for new construction: short PlaVsubdivision Lot No. (enact,copy Of long legal description) <br /> OWNER Phone/E-mall <br /> Address City/State/Zip <br /> APPLICANT'_Owner _Owner's Agent Contractor _Contractor's Agent Tenant(m-t pmvida Q latter of wrn ent Rom thg owner to do work In the/apace) <br /> CONTRACTOR State Lic.# e CityBus. LIG.#b of $ d 0 <br /> Address 01 . tL �� a g � 1043 PhonetEfnail Dip -a q 9 - —)A 0p <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT JaA M t t ,-� <br /> Phone/E-mail rY 'l A- - e'ole <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gazi—k Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.I. SI n Sprinkler demolition Change of Use <br /> pES RIPTION OF WORK(additional space provided on the tie <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn 61ttration <br /> _Repair Type of Project: _New___Addn ,,,,-Alteration Repair <br /> Show Nu of fJxtures Show Number 0of fixtures <br /> A!C it handiin units Toilet <br /> orced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran a 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 /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ductino 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.Ali provisions or laws and ordinances governing ihi3 type of work wlll be comp <br /> W <br /> specified herein or not.The granting of a permit does not presume to give authority to vlolats or cancel the provision of any other state or local law regulating con*truuWn <br /> The t am authorized by the own r of this property to perform the work fo which a licetion a made and I comply with the State Contractors 1-6w 18.27 RCW and 296.200A WAC. <br /> l f <br /> nertAuthorized Agent$ignaturo Date `�� (Revised 9/2094} <br /> r <br />