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PERMIT APPLICATION <br /> BUILDINGIMECNANICAL/PLUMBING/SIGNISPRINKLERIDEMQLITIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, INA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# <br /> 0. gAV-4_ Ito4 Ct a \ 1 <br /> LEGAL for new construction: Short Piat)ssuubdivision J Lot No.______. (attach copy of long legal description) <br /> Q <br /> OWNER K CaPhone/E-mail • tW l a <br /> Address City/SlatelZip <br /> APPLICANT: Owner ____Owner's Agent Contractor -Contractor's Agent u Tenant(fnt)%t provide a teettte�r at consent from the owner to do wank in the spare) <br /> CONTRACTOR State Lic,# K-`'7 City Bus. Lic.#og 9 0 <br /> Address 41 5 1 4� L t*S Phone/Email •pt,, •a "f 19 - CJC� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT JaX tYml k CD <br /> Phone/E-mail •1-C 6D <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building _ HEAT SOURCE'. <br /> Proposed Use of Buil g Gas Electric Other <br /> Building type: Single Family __ Duplex_Townhouse Multi-F,miiy ,—Commercial <br /> Type ofproject: New Addition Remodel Repair --TI, Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(addirio i space provided on the back) <br /> R,L—pl Q C <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn I Alteration_Repair Type of Project: _New__Addn _Alteration_Repair <br /> Show Num of fixtures Show Number # of fixtures <br /> A/C air handling units Toilet <br /> orced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran a Dishwasher <br /> Clothes dryer Clothes washer <br /> i <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mo tete. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> i Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM Other: <br /> Other: <br /> Number of Heads <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of taws and ordinances governing this type of work weal be comp <br /> ;n*;r'�1A-uthorfzed <br /> hether 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 conslvcuon <br /> m authorized by the own rot This properly to perform the work t whicn pticatidn is made and i comply with the Stale Contractors Law 1$.27 RCNJ and 296.200A WAC. <br /> Agent Signature Date <br /> (Revised 912014) <br />