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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 ypD SS' TOPERTY TAX# Py MI # <br /> _ _tM ',� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER f Phone/E-mail q2-5 <br /> 25-' (6 <br /> Address ;� �(J J SvCity/State/Zip f <br /> APPLICANT:—Owner _Owner's Agent —Contractor —Contractor's Agent I Tenant(must provide a letter of consent from the owner to do work in the space) <br /> U(Z) �P(� � <br /> CONTRACTOR �l ��1� l� 7i 1 �J(Z) State Lia# City Bus. Lie.# <br /> Jr ', <br /> Address ��' -� t Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ,n <br /> ff -- r1 Cn �V l <br /> Phone/E-mail r�v�L/_ -) J <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ?i o <br /> Existing Use of Building l aV—C ®�1 L � s L 7 HEAT SOURCE: <br /> Proposed Use of Building �� Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family Commercial <br /> Type ofrow e1 ct: _tJew .—Addition _Remodel _RepaiT <br /> r Y SI.___Signn_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WO K(additional space provided on the back): <br /> V�sve 03A <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 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 7 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 I 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 comp) <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 slate or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work four which application is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent ignature Date (Revised 912014) <br />