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PERMIT APPLE. CATI 4 <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 /> 1-0 t�Al i <br /> SITE AD RESS: <br /> FPRERTYTAX#77:� P�IERMIT# i <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:—Owner —Owners Agent Contractor —Contractor's Agent _Tenant((must provide a leiterof consent from the owner to dp work In the sGpace) <br /> CONTRACTOR /U �/� �� ` State Lie,# ff L /vim City Bus. Lic.#e, / <br /> Address /�. /�, ��'>� �ry 11 ,4)1 l(0 �?i; Phone/Email Z 2 <br /> TENANT bUbliNtS.5 NAME :Phone/E-mail <br /> TACT FOR PERMIT <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR►c-�/ � <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 of project: _New _Addition —Remodel _Repair.T.1._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK/(additional space provided own theebback): <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 �610 37V Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backfiow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> i 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 t owner oft is property to perform the work forwhich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ` ,UOd 3 - <br /> / ut ze Agen Sig a ure <br /> Date (Revised 4/2015) <br />