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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 /> ro 130Y- 004 <br /> SITE ADDRESS: PROPERTY TAX If PERMIT# <br /> e `J? 3g7 —S'T B /30f`- ooh <br /> LEGAL for new construction: Short Plat/subdivision T- Lot No. (attach copy of long legal description) <br /> OWNER /frll ST ,F4,vestrix.14 [ Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT: Owner —Owners AgentA _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR D�(7 P`� blr5 State Lic.# .D pA V O 7 7 kJ— City Bus. Lic.# <br /> Address ')qv-2_ S e�c't'mrn RcX 5'u,e h nhl i Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <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 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 /> 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 /> NC—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 I Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood ? Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump. C Backflow preventer <br /> Unit heater Urinal <br /> f Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other - ; Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM / ( Other: H0.5‹ br'6 <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 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 /> Owner/Authorize. Agent Signature Date (Revised 3/2013) <br />