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PERMIT APPLICATIiN <br /> BUILDINGIMECHA ICAL/PLUMBING/SIGN/SPRINKLER/®EMOLITIO <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 ADDRESS: PROPERTYTAX# PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER CJtJ(/ lLaoGbt,t,JA Phone/E-mail <br /> Address l �(v ., _ (/ City/State/Zip LCej4j, �G <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR 0 rt c <br /> State Lic.# (� City Bus. Lic.#�3 65 <br /> �"/ cr''��� Phone/Email <br /> AddressTENANT 13051RESTITAW b (sCa� 7 <br /> AC FOR PERMI <br /> Gll)IG�S ��/�(['(iiF�t 1�✓ Phone/E-mail Li q-- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building ( l a"ch HEAT SOURCE: <br /> Proposed Use of Building ���✓�'L Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family ,.Commercial <br /> Type of project: _New _Addition Remodel _.Repair_T.I._Sign_Sprinkler_Demo lition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ���CL�i� �ri �/ �-►r�'l <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration_Repair Type of Project: _New_Addn ,_,Alteration'Repair <br /> — <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(inside bldg) <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 exam i a plication 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 <br /> w her specified herein o e granting of a :at"o <br /> does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Th am thorized y owner of this property to pe rm the work for which a plication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r utho z d -- <br /> J� ate (Revised 4/2015) <br />