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� <br /> 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 /> SITE AnnRFSS� - PROPERTY TAX# PERMIT,# <br /> �07, <br /> LEGAL for new construction: Short PlaVsubdivision Lot No.L (attach copy of long legal description) <br /> OWNER ()�1_�O/v F K-�j'� ���' Phone/E-mail "ZS �" ' ���`� <br /> Address D`1�O �T()(,�j 1�.� �� City/State/Zip � ��,� LV� ���� <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor'S AgOflt _T@flaflf(musl provide a lette�of consent from the owner lo do work in the space) <br /> CONTRACTOR �l �J State Lic.# �G I <<(�C (�,.��r,-i�ity Bus. Lic.# <br /> Address C� p(� �( V I ti`� �/� Phone/Email �� 3`-s �`z`}L�� <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 /> DESCRIPTIO OF WORK(additional space provided on fhe backJ: <br /> �� � e da�61� � <br /> ��� � ��.vG� L'� i� <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(#J of fixtures <br /> A/C—air handling units � Toilet <br /> ( Forced air systems 2 � Bathtub <br /> j Gas piping � Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace � Kitchen sink&disposal <br /> � Gas range Dishwasher <br /> I. Clothes dryer j Clothes washer <br /> Range hood j Water heater <br /> � Exhaust fan � Sink(service/bar/mop/etc.) <br /> � Heat pump I Backflow preventer <br /> i Unit heater Urinal <br /> �,r''' ! Boiler � Drinking Fountain <br /> � j Refrigeration ; Floor drain <br /> ; Woodstove I Grease trap • <br /> Ducting ; Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> Number of Heads i Other: <br /> I hereby ceAify 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 properfy t ertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � l <br /> (� nar/Ai thnri�Pd Anenf Sianature Date (RBVISBd 3/2013) <br />