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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 98209 425-257-8890 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PR C ERTY TAX# p, RM1T# _(1l <br /> LEGAL for new construction: Short Plat/subdivision ____Lot No. (attach copy of long legal description) <br /> OWNER - Phone/E-mail <br /> Address-P. a a City/State/Zip E4W <br /> APPLICANT: Owner __Owner's Agent _l Contractor Contractor's Agent ___Tenant(must provide a letter of consent from the ovmer to do work in the space) <br /> CONTRACTOR /� C State Lic.#i3�;y J q Q City Bus.Lie.#0591-15D <br /> Address 5,1cD Ji� �C /-lwi al' r�Cf Phdne/ ma1�SS-("/$,�f <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> t-LQ-.li A If1(tLC Snf\ ') S-995 D 5 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKS <br /> Existing Use of Building_ _ HEAT SOURCE: <br /> Proposed Use of Building______ ____ Gas____. Electric___ Other_ <br /> Building type: ___Single Family Duplex_Townhouse __Multi-Family Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin—Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> lry 1✓kl� 661 ShVl-�) S)Vl ICS all <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New__ Addn --Alteration__Repair Type of Project: _New_Addn )CAlteration_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 Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer inside bid <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refri eration 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 goveming 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 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 made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> o <br /> Owner/Authorized Agent Signature I Date (Revised 4/2015) <br />