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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 vwvw.everetiwa.org <br /> SITE ADDRESS: PROPERTY TAX N PERMIT# <br /> 0 3I Lnw a.// � �vrJ �0� ' r�`'G <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER ��, Z �'f �-.L� Phone/E-mail <br /> Address �60,3G V/1�isy.1 /(v2 N�✓ City/State/Zip .�.P.�,fj`lj /�//f 9 �i /?7 <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor�S AgOflf _TBIl811t(must provide a letter of consenl from the ovme�to do work in the space) <br /> CONTRACTOR („��� , � State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 /> T e of ro�ect New Addition ✓ Remodel ____. Repair.,�T�I. �. Si�n „W Sprinkler_.,�cDemolition__ Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the 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(#)of fixtures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater � Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e � Dishwasher <br /> � Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> � Heat um � Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other. ' c:� � f `�. Y�V��E= <br /> Number of Heads I Other: <br /> I hereby certify ihat I have read and examined ihis application and know the same to be true and correct.All provisions of taws and ordinances governing this type of work will be compl <br /> with whether specified herein or not.The granting of a permit does not presume lo give authority lo viola�e or cancel the provision of any other state or local law regulating construclion <br /> That I am authorized by the owner of this property to perform the work forwhich application is made and I comply with the State Conlractors Law 18.27 RCW and 296.200A WAC. <br /> X ��L �, ��Z Z/23fiS <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />