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K <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRIN KLER/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 /> SITE ADDR S: PROPERTY TAX# PER T# <br /> �l- <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 _Tenant�must Proviae a ieaer orconsenc rrom tne ownerco do work in u,e sPace� <br /> CONTRACTOR State Lic.# � ity us.Lic.# <br /> Address �� x � Phone/Email 2 � g' • ^ I/�w � <br /> TENANT BUSINESS NAME L�'� <br /> ^ C�ITACT FOR PERMIT .�� <br /> Y���yty S C�r rte�~ JPS<SI L2� . 1�� ca-ow�'m <br /> Phone/E-mail s � <br /> BUILDING PERMIT APPLICATION coNTRaCr PRicE oF woRK . ��� <br /> _��7. <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Buiiding Gas Electric other <br /> Building fype: _Single Family _Duplex_Townhouse _Multi-Family ,�Commercial <br /> T e of pro'ect: New Addition Remodel Repair T.L Si n S rinkler Demolition Chan e of Use ' <br /> DESQRIPTION OF WORK(additional space provided on the back): ' <br /> ��.d c�� hea.ds <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(#)oifixfures Show Number(#)of fixtures <br /> A/C—air handlin units � Toilet � '-- <br /> Forced air s stems Bathtub ' <br /> � Gas i in ' <br /> � Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher ' <br /> Clothes d er � Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan � Sink servicelbar/mo /eta <br /> Heat um Backflow reventer inside bld <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain � <br /> Refri eration Floor drain � <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> : Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: ' <br /> ; <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this appliration and know the same to be true and correct.All provisions of laws and ordinances goveming this type of work will be comp <br /> with hether specified herein or not.The granting of a pertnit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Th I m authorized by the ow of his property to perform the work for which appiication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � . �,.��.;.�, -_.. <br /> wne uthoriz Agent igna ure Date (Revised 4/2015) ,� �"`y- <br /> �"�•_._, <br />