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OPERMIT APPLICATIu+4 <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 ADDRESS: PROPERTY TAX# PE IT <br /> 14iP Rcthce�e 1 6, Ave.. - P)D <br /> lt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER MRnQVe McLeod Phone/E-mail 45 3-5 Ct Z,SS . <br /> Address Po atm LZ.DS.-7 City/State/Zip _Eu.ere-ff 2.06 <br /> APPLICANT: 2c Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to rip work In the space) <br /> CONTRACTOR otijilj{' State Lic.# City Bus, Lic.# • <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building S i lks5A.e -41►1AI ly 1't�5'1c�eltit� HEAT SOURCE: <br /> Proposed Use of Building J 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): <br /> epee waier IneaA-er <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 /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> 1 I 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 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 Grease trap <br /> Ducting Roof drains • <br /> Other , Medical Gas <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 applic tion is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> t2cL & b_(")-6/S <br /> Owner/Authosiked Agent Signature Date (Revised 4/2015) <br />