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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 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT it <br /> LEGAL for new construction: Short Plat/subdivision ®� Lot No. /S (attach copy of long legal description) <br /> OWNER P,4444 C-J iT/$�� 3'®/`.� Phone/E-mail ®� Zg�o®��� 6��'/3'°�d6�� •� W'- <br /> Address ®�®� � ��- City/State/Zip • <br /> APPLICANT: ✓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 0 W AlShL L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ZPhone/E-mail A4 fJ1/ ✓'! '49 AJ <br /> (�7 M A <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_.I <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas _lectric Other <br /> Building type: VSingle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair_T.I. Sign_Sprinkler_Demolition✓Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 1-t <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 air systems 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 I Other: <br /> INumber of Heads I 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 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 18.27 RCW and 296.200A WAC. <br /> caner/—A)Ilthorized Agent Signature Date (Revised 6/2092) <br /> t <br />