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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SP RINKLER/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 /> 5 0 -DL09 <br /> SITE ADDRESS: r �h n PROPERTY T � O© PERMIT#� <br /> LEGAL for new construction/: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> c �� �1 <br /> OWNER (' <br /> �/O ® ;f= Phone/E-mail <br /> Address / iD t,'f Iw-rk 'Sec- omt)q City/State/zip <br /> APPLICANT:—Owner —Owner's Agent 4Contractor —Contractor's Agent —Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ib State Lic.# L ?)SRSCity Bu-s..7Lic.# 61 5 <br /> Address/ ¢ �.�LSO itb t� i';f Phone/Email V,? �`�Y v� /3 <br /> TENANT BUSINESS NAME /� j N CONTACT <br /> FOR PERMIT <br /> .5-j- ,/ <br /> ._ ( i toy ' ` �(� Phone/E-mail ft, 2 Yy - 7? <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: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WPRK(addition/al space provided on the back) <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 7. Sink (service/bar/mop/etc.) <br /> I Heatum Backflow reventer inside bldg) <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 comp) <br /> ILwith whether sp cified 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 auth e�d by/the owner 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 /> net Authorized Agent Signature Date (Revised 42015) <br />