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PERMIT APPL,ICATI V <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 /> • <br /> SITE ADDRESS: PROPERTY TAX# PENT#` J�� <br /> t Lc IAM-1.4.- r�//`1 .3 <br /> LEGAL for new construction: Short Plat/subdivision e I • <br /> Lot No. (attach copy of long legal description)• J <br /> OWNER C. f) TO� PU.CT AJ Phone/E-mail 4 yc-7 73-296 L I J vt'l i S' n/G 4f� !1 <br /> Address )-/UIQ S r- S C` City/State/Zip Eu2 WA Ofta 1 <br /> • <br /> APPLIC' T:4 4 Owner Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR 6 uu I1 State Lic.# City Bus. Lic.# • <br /> Address - Phone/Email <br /> CONTACT FQR 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 SiNA1,6 Gas_ Electric k Other_ <br /> Building type: Single Family _Duplex Townhouse sr Multi-Family Commercial <br /> Type of project: _New Addition _Remodel _Repair_T.l._Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): ' <br /> G't, 106IA.opi-Dusd _ Po"'; Ai'44£ '/Laafri f-/ Akr to 1'4, o <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 /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin). <br /> I Water heater { Shower • <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer <br /> { Range hood Water heater <br /> Exhaust fan { Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> { Boiler Drinking Fountain <br /> { Refrigeration Floor drain <br /> { Woodstove I Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> • • <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <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 /> / (1� , <br /> Owner7Auth • VA�E!'rzed Agent Signature Date (Revised 4/2015) <br />