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AUG/16/2017/FRI 08: 32 AM Nor6Creek Roofing FAX No, 425 46524 P. 002 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/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' PROPERTYTAX# PERT O h <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) V <br /> OWNER , �Le,� Phone/E-rnail <br /> Address k Gity/state/Zip <br /> APPLICANT:—Owner _Owner's Agent -)�-Contractor —Contractors Agent _Tenant(must provide a tet(erof coneenfrom the ownwW do work in the epace) <br /> CONTRACTOR 1 L&I Lic_# COE Bus. Lic.#"O'Szl ` I <br /> AdtlressU�t K�` �XuL ' A •*- Phone/Email Co <br /> TENANT BUSINESS NAME COIqTACT FOR PERMIT <br /> Phone/E-mail ''t om 3 T -`'o b <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Useof B ilding Gas_ Electric Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type ofproject: _New _Addition —KRemodel _Repair_T.I._Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORD((edditionaf space provided on the back): <br /> C.cWv <br /> ,V-% . <br /> MECHANICAL PERMIT APPLICATION P-LumaING PERMIT APPLICATION <br /> Type of Project: _New_Addn _AifaraVon_Repair Type of Project: _Now_Addn _Alteration_Repair <br /> Show Number # of fixtures Show Number offxtures <br /> A/C air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavato 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/mo /etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> h Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby cerITy that t have read end examined this application and know the same lo be true and correct.Ali provisions of laws and ordinances governing this type of work will be complied <br /> wile 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 stats or local law rsgulating construction <br /> That I am authorized by the ownerof this property to perform the work forwhich application is made and I compty with the State Contraotoks Law 19.27 RCW and 290,200A WAC. <br /> In*or/A'frtho;n�z7 d Agen ture Date (Revised 6/2012) <br />