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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 Df) ESS: PROPERTY TAX N <br /> ,V-4— P 71 <br /> LEGAL for new construction: Short Plat'subdivision Lot No­­ (attach copy of long legal description) <br /> OWNER -C Phone/E-mail 1)0 1�) - <br /> Address City/State/Lip <br /> APPLICANT:—Owner Owner's Agent XContractor —Contractor's Agent _Tenant(rnusl provide a letter Oconsent from rhe ow-t tri do work.n the space) <br /> CONTRACTOR State Lic.#[3(44","kXqql M City Bus. Lir,.#c)Q a o <br /> Address q (.#01 5 1 1 JPhorre/Em.il ko q 19 - -JA oiz> <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT_)IXA y-n%< CD <br /> Phone/E-maili W YY\t A-ci)b kl�4� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building S!F '\72- HEAT SOURCE: <br /> Proposed Use of Buil-ding Gas.,"" Electric- Olhet­ <br /> Building type: t-­-S-Ingle Family _Duplex Townhouse M -Fmily Commercial <br /> 'rype of project: New Addition Remodel ----Re air I Sign -, Sprinkler­Dernolition Change of Use <br /> DESCRIPTION OF WORK(additional space pr tried an title 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(#J,of fixtures <br /> A/C-air handling units Toilet <br /> Forced airs stems Bathtub <br /> ---r- <br /> Gas piping Layatory(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 Backfiaw preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Cuctin l 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 10 be true anti correct.All provisions of laws and ordinances governing this,type of work will be comp <br /> whether h it 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 /> wo)(or n happli-a <br /> h. I am uthonzed by the ow f this property to perform the tion is made and I comply with the state Contractors Law 18,27 RCW and 296,200A WAC. <br /> VA- <br /> w <br /> n.,lA th.trimed Agent Signature . Date (Revised 912014) <br />