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PERMIT APPLICATION <br /> BUIL®ING1I! ECHANICAL/PLUMBING/SIGNISPRINKLER/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 /> SITEAD/DRFcc• PROPERTY TAX 4 PERMIT## <br /> LEGAL for new construction: Short Plat/sulaclMsion r 11 Tl u Lot No.&-10 (attach copy of long legal description) <br /> OWNER S'�(;t ��1' i C C�l(� 1' _ ' Phone/E-mail 1155 2F00 <br /> Address -0 S.") x�1t---U\q­�Lo—o CitylStelelzip rtf')(Z � LAA4 qY204 <br /> APPLICANT: _Owner ___,Owner's Agent XContractor —Contractor's Agent _Tenant(must proylds a lettef of consent frern the arvner to do v.ofk In tho!paca) <br /> CONTRACTOR MLUf .(Oct 01tiMbiWt geifiri6)) State Lic.# �-f� i r� �`t,�� ���1 City Bus.Lic.# <br /> 1' <br /> Address _ al, OxId t {1 11�i {1vIn0r4J. b v1� Phone/Email <br /> TENANT BUSINESS NAME C NTACT FOR PERMIT 1 l <br /> Phone/E-mail �Z� � ✓ 5 oc) <br /> BUILDING PrRMIT APPLICATION CONTRACT PRICE OF WORKT P47 ��/�• �� — <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 ro ect: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additlonal space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLiICATION <br /> Type of Project: _Now—Adds _-Alteration•„_Repalr Type of Project: _New Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Nwnher(#)of fixtures <br /> A/C--air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas p1ping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Rangishood Water heater <br /> Exhaust fan Sink service/barlmo letc. <br /> Heat pump Backflov/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 /> f"Z? Number of Heads Other: <br /> [hereby ce"that i have read and examined this application and know the sarno to be wo and correct.Aft provisions of laws and ordinances governing this type of vrork vrdl be comp <br /> With whetherspecifled herein or not.The granting of a permit does not presuma to give authority to violate or cancel the provision of any oilier state or local law regulating censtructton <br /> Th rn authorize by the ow of this property to per orm the work for whl�h applicaton)s made and I co p y vrih the State Contractors Law 18.27 RCW and 2t?^o.200A WAC. <br /> I La <br /> Owner! u horize Agent Si ure Date (Revised 9/2014) <br /> i <br /> ��,� <br />