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• PERflTAPPLCATIif• <br /> C��9AL®INGILCC�AG�oCALIPUMBI��GI50 �9/S6�' Uh��Pl1� R *LIMN � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett WA 98g01 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX#t ER <br /> h • �.l✓ oY <br /> oigoo/0000c) �1f 1L CVC <br /> f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER -(1 .,:-":-/7- 1/0L/S/N16- .4-aV{CR/TLf Phone/E-mail ,--/2..) a 3 yC/G _ <br /> Address 3107 COAL AL . CUAi-?L/7 1 " 9 ,)-6/ City/State/Zip (/�7?z5:77-,4 L�,q ?9oP-C)/ <br /> APPLICANT: Owner t--'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 A 1...1,I2-f-_-P Cc90S /../C'T-/ State Lic,# ;4LL-rC/a oogDg City Bus. Lic.# (9 3762?, <br /> r/r L gL_17- m/7/ Phone/Email // 2_J-9 — ,,60— <br /> Address _3/2(9 7-71/:- .///7 � I <br /> 1 , 1 :1 a . . r CONTACT FOR PERMIT <br /> /. /:_-_--,j <br /> i=wi VA 0e1,3,?i- 7- • <br /> Phone/E-mail 2{2.1 -3 8 -'/ f <br /> c2/G ' Ve Ej/, G- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ,44 oDO E5-7-yf"`4' <br /> Existing Use of Building SiT LL= 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): 5 u C �) � i-u%u 7r <br /> p50-).D S 7-0 2. 61_,4 �6,//k_17 y <br /> F /11D J6 5/ 7--- , <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 1 Lavatory(wash basin). <br /> I Water heater I Shower <br /> I Gas fireplace Kitchen sink 8,disposal <br /> Gas range - Dishwasher <br /> Clothes dryer Clothes washer <br /> I 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 /> SPRINKLER / SUPPRESSION SYSTEMOther; . <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 rmit 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 uthorized by the owner of t - property to erform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 1 t /i(A //0/ -- (Revised 4/2 15) <br /> A <br /> Owner/Authorizedent Signature Date 9 <br /> • \ 1 2 <br /> I <br />