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Qa t I i'aa[(e- kr <br /> vagmeo-i <br /> PERMIT APPLICATION (94) g0�-fD;q15 <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROP TY TAX# mnc�� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Uy Phone/E-mail <br /> Address Ml.: 2 f SE City/State/Zip 6,\Jeye "} �, q <br /> APPLICANT: Owner _Owner's Agent Y,Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTORCOE(Bus. Lic.#()q(3J657 <br /> AddressSa S- 3 Phone/Emai L� <br /> TENANT BUSINESS NAME CONTACT FOR PERHiIT� 1 t AL <br /> O�t <br /> \ Phone/E-mail - ' —L L , <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK E.0 . <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of uilding — Gas Electric Other <br /> Building type: Single Family Duplex_Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WWK(additional space provided on the back): <br /> STU <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _kNew_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 <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 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 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 b the owne:ofthis property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I4._7 <br /> Owner/Aut rized Agent Signature Date (Revised 6/2012) <br />