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A1 <br /> tERMIT A,PPLAC,ATI <br /> BUIL®ING/MECHANICAL/PLUMBING/SIGN/SPRINKLERMEM®LITI®N <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• /�, '�:'/>c PR �T TAX ,��S co PERMIT# <br /> LEGA for new construction: Kort Plat/subdivision !Q a Lot No.J­ (attach copy of long legaldescription) <br /> OWNER '(_ Phone/E-mail l r <br /> Address L" /– )– - / City/State/Zip <br /> APPLICANT: Owner /Owner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BL 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 BuilddLng / ` ' Gas J Electric_ Other <br /> Building type: Single Family Duplex _Townhouse _Multi-Family Commercial <br /> Type of project: Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION K(additional space provided on the back): <br /> r L- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Adds —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 i Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace j 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(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 id 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 herei, 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 aut oft " pr' erty 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 /> Owner/Auth 'z d Agent Signature Date (wised 4/2015) <br /> �r <br />