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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 /> SITE qQ fSS �v� T <br /> PERTY TAX# P6 ILI1#o v'`c L <br /> LEGAL for new construction: Short Plattsubdivisicn Lot No. (attach copy of long legal description) <br /> OWNER J�{ Phone/E-mail 25 ` <br /> Address (� J �boy 131A City/State/Zip 1 � '� <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR : 7� �fi `�%��(✓ 1✓ i State Lic.# City Bus. Lic.# � <br /> n r)t <br /> Address �/tt� ty Phone/Email <br /> TENANT BUSINESS NAMECONTACT FOR PERMIT <br /> r? 1 <br /> '-A Phone/E-mail _F-I✓, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Uµ �u� Jg1 �Z HEAT SOURCE: <br /> Proposed Use of Building S Q�Q. _ Gas Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family Commercial <br /> Type of project: _New ,Addition Remodel ___-RepairTSI. Siyn__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_Addn _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 Lavato wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood c ► Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 compl <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 rgade and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. Y <br /> Owner/Authorized Agent ignature Date (Revised 9/2014) <br />