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• i <br /> PERMIT APPLICATION <br /> BUILD1 NG/MEC HANICAL/PLUMBING/SIGN/SPRIN KLER/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 /> SITE ADDRESS: PROPERTY TAX# PE MIT# <br /> 1�:Zt' iV v- <br /> LEGAL for new con structi Plat/subdivision No.__!J_ (attach copy of long legal description) <br /> OWNER - -, r Phone/E-mail J..=w �r� ✓���u✓1i C vlC j�jrCc� <br /> Address'�'�� City/State/Zip <br /> APPLICANT:X Owner _Owner's Agent _Contractor -Contractor's Agent _Tenant(must provide a letter of consent from the owner 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 Cc,me GAS abOUe- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building laahgacz Gas_ Electric_ Other <br /> Building type: _Single F ily —Duplex_Townhouse —Multi-Family _Commercial <br /> .1ype ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Q` �o5m aUIY a�.e, <br /> LC, `I 5 F J <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 airs stems 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 compl <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 constructi <br /> That I am authorized by the o er of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WA <br /> r � <br /> O ner/Authorized Ag t Signature Date (Revised 9/2014 <br />