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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIS KLE /DEMGLI TION <br /> CITY OF EVERETT PERMIT SERVICE <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 P RMIT# <br /> i PROPERTY TAX# <br /> SITE ADDRESS: j ' t ,! . 1 0 " W01,4 <br /> LEGAL for new construction: Short PlaUsubdiv elan <br /> Lot No (attach copy of long legal description) <br /> rr <br /> OWNER Phone/E-mail City/State/Zip GYr': "" ' <br /> Address <br /> APPLICANT:__Owner Owner's Agent '. ._Contractor _Contractor's Agent Tenant(must p,ovide a latter of consent how the owner to do work in tN space) <br /> COE Bus. Lic #1-12,,.17) ' <br /> L&ILic # <br /> CONTRACTOR � , <br /> Address , - <br /> .V,\, • <br /> __ I CONTACT FOR PERMIT Pnone/Email . _. . - <br /> TENANT BUSINESS NAME .j I. i . <br /> PhonelE-mail <br /> CONTRACT PRICE OF WORK <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building HEAT SOURCE: <br /> � - <br /> Gas Electric_ Other_..__._ <br /> Proposed Use of Building `' <br /> Building type: i Single Family _Duplex_Townhouse Multi-Family )/`• Commercial <br /> Type of pro'ect. __ New __ Addition Remodel _ Re•air i_4•Z__T.I. _ Sign_Sprinkler _Demolition_ Change of Use <br /> DESCRIPTION OF WORK iaud+Mortar space prowled on the back} t � <br /> ` ��•(V — #ti'.i 4.... 1k) ,- {_?�,i,,,,--, , --1 , <br /> V��� ; 7 <br /> _.. <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn +_;Alteration Repair <br /> Type of Project: New�Addn Alteration!Repair Show Number(#)of fixtures <br /> Show Number(#)of fixtures Toilet <br /> NC-air handlin units Bathtub <br /> Forced airs stems Bath to (wash basin) <br /> Gas pion. Lava <br /> • Water heater Showerohen sink&disposal <br /> Gas firepiace <br /> Gas ran e Clothes washer <br /> Clothes dr er Water heater <br /> Ran e hood .�_ Sink(service/bar/mop/etc.) <br /> Exhaust fan Backflow preventer <br /> Heatpum• <br /> Unit heaterDrinking Fountain <br /> Boiler Floor drain <br /> Refrigeration Grease trap <br /> W sting Roof drains <br /> Ducting Medical Gas <br /> Other ;k Vit.: i_ Othei !=� <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads Other: <br /> on and know the same <br /> o be true <br /> d correct <br /> rovisions of laws <br /> ordinances governing this <br /> e of work will be <br /> a hereby certtfy!hal id have read snot The n of alpennit does not presume to give authority to violate All <br /> or cancel the provision dof any other state or local latwregulating construction lied <br /> with Iam authorized <br /> orip specified herein orgranting <br /> That i am guthariXed by Ina owner atthi3 property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 298 200A WAC <br /> i / J ( i <br /> j Il 7 <br /> .. (Revised 6/2012) <br /> OwnerlAuthorizod Agent Signature <br /> Date <br />