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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 1-4, (Q 10 <br /> SITE ADDRESS: 1PROPERTY TAX# PERMIT# <br /> Z3QQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent ____Contractor Contractor's Agent n de a tetterof con _ r the owner to dt; <br /> wo <br /> CONTRACTOR S�� YA r P -e L&1 lc:# T OE s.'-c-# <br /> Address �a 35 cj PhonelEmail •' 135bt C 1(' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT t VC �V A <br /> .��I YV1 S}�V�Cxr`} <br /> Phone/E-mail3bV• 5(ob -ACI5 1-C'tY 1NQr A1V Cb W` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 71. loo <br /> Existing Use of Building_MCI \J+Ckchi r Yea HEAT SOURCE: <br /> Proposed Use of Buildingay-OL 01r-z Gas_ Electric Other_ <br /> Building type: Single Family.. Duplex Townhouse W_ Multi-Family x Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New—Add. Atteration_Repair i 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 /> i Gas fireplace Kitchen sink&dis osaf <br /> Gas range Dishwasher <br /> I 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 /> OtherMedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads ° Other: <br /> I hereby certify that 1 have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this typeof'worte vvflPbe compiled <br /> with whether specified herein or not.The granting,of a permitdoes not presume to give authority to violate.or cancel the provision of any other state or local law regulating construction <br /> That(am authmized by the own f this property to perform the Nark fm'v w»e h appBc&6on is made and t comply with the State Contractors Law 32.27 RCw and 296 200A WAC. <br /> I(J25 Lo <br /> Own r/Authorize Age t g lure Date (Revised 6/2012) <br />