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PERMIT APPLICi4TION <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 /> I� <br /> SITE A DRESS � �� PROPERTY TAX# PERqIIIT# D <br /> � �� 7 _� �� <br /> LEGAL for new construction: Short PlaUsubdivision��Q���Q��-DaC� Lot No. � (attach copy of long legal description) <br /> OWNER Ll�Lu � L—�(J Phone -mail �� ��(/m�iC//�n�C <br /> Address��� �� y�n �/� City/State/Zip Cj,/�' /�/ /� 9 a/D <br /> APPLICANT:✓wner _Owner's Agent _Contractor _Contractor�S Ag2fll _T@f1811t(musl provide a lelter of conseN from the owner to do work in the space) <br /> CONTRACTOR f� L State Lic.# �f7L� 7]P� City Bus. Lic.# ��ry�1 <br /> Addressya� 7� ��� �� ��r v`�/C Phone/E'Tfi'�i�� � �� ,C�U����C. <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: �ngle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: ✓New Addition Remodel Repair_T.I._Sign_Sprinkler_Demolition Change of Use <br /> DF_SCRflPTIQN OF WORK(additional space provided on the bacic): <br /> �� ' �C ��Cf1� ��/�Dl'Da/ <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 fixfures Show Number(#)of fixtures <br /> I A/C—air handling units Toilet <br /> � ( Forced air systems Bathtub <br /> Gas piping i Lavatory (wash basin) <br /> Water heater 2. � Shower <br /> j Gas fireplace ( Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> ; Clothes dryer � Clothes washer <br /> j Range hood ( , °'"� <br /> � Exhaust fan i Sink(service/bar/mop/etc.) <br /> � Heat pump j ' Backflow preventer <br /> i Unit heater i Urinal <br /> ,� ; Boiler j Drinking Fountain <br /> �`��, i�%" "�.Re�e�g a ' „, ! Floor drain � <br /> ! Woodstove � Grease trap <br /> I Ducting ! Roof drains <br /> � Other � Medical Gas <br /> I <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> � Number of Heads ; Other: <br /> I hereby certify ihat I have read and examined this application and know the same lo be true and correct.All provisions of laws and ordinances goveming 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 1827 RCW and 296200A WAC. �/Z ;,% <br /> 6 <br /> � ��'� ���/���'/ : ; <br /> Owner/A orized Agent Signature Date (Revised 3/2013) <br />