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PERMIT APPLICATION <br /> BUILD1 NG/MEC HANICAL/PLUMBING/SIGN/SPRINKLEWDEMOLITION <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: T06q-3c7 <br /> ROPERTY TAX# PERMIT# <br /> 25 362- 1 Std — D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER d� Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent 4 Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Qq df <br /> ✓f L&I Lie.# Q COE Bus. Lie.# <br /> Address �� �G'J Phone/Email if < <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��%T <br /> Phone/E-mail 5` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building / 7p J / HEAT SOURCE: <br /> Proposed Use of Building 'Sam-(J Gas�k�- Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family Z Commercial <br /> Type of project: New Addition Remodel Repair_T.I. Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION O` F��vORK(additional space provided on the back):F-VI <br /> AI <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(#)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 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 /> C Owe Authorized Agent Sig ure 411 / Date (Revised 6/2012) <br />