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PERMIT APPA CATIo11� <br /> BUILDING/UF__CHANICAL/PLUMBING/SIGN/SN-sfliNIK ER/DEMO ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 08201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> L <br /> LEGAL - <br /> for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> y� <br /> OWNER Cao r$Crn 44.0 �i�`120�1 ' Phone/E-mail ijZi q C 3 5 (c( v <br /> Address 73 1 ` �j /'i , ( Kcy!t-11(.4, City/State/Zip ," (1J Kfr / 87 ( <br /> APPLICANT: 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 l ori45 �YO .- -State Lic.# (.; ) O7) 2 �CIty Bus. Lio.# Oil 31/`1 <br /> Address .3 3/ Pl^04�Gfl 1)- 7,6.1. pip, 5vid ( Phone/Email q25 --3i1-55/ a <br /> .. . .. , • s r —--- CONTACT FQRERMIT <br /> e j e_ tU ca1 to / 5-,A,........,_,_Phone/E-mail 9-I-es.',.SA_i k- 1 (29- 4 -3 . r - <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> • <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 t back): o � �S L� n _ ` � � r� <br /> p LCtY t o t)Get. 6 1-CJ`? L <br /> i n 4&.r//I')C- `if l <br /> MECHANICAL PERMIT APPLICATION I 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 Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan j Sink (service/bar/mop/etc.) <br /> Heat pump r Backflow preventer(inside-bldg) . t 5;- <br /> L. <br /> Unit heater Urinal <br /> Boiler Drinking Fountain • <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other — Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> 1 <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 thorized bythe o er 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 /> �- /, - /0 "24 " 1 <br /> wnerlAuthorized Agent Signature Date (Revised 4/2015) <br />