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Mar 29 2015 04:29PM CJ'S PLUMBING & SERVICE 360-691-1301 pi9i I <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUIUIB f NG/ <br /> SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 <br /> SITE ADDRESS: wW W.everetfwa,Or9 <br /> ' Zi \ PROPERTY TAX# <br /> • -ERMIT# <br /> LEGAL for new construction: Short PlaUsubdivision 0 —aa° <br /> A` lot No. (attach <br /> de <br /> h'S copy of long legal description) <br /> OWNER r <br /> Address Phone/E-mail <br /> 1 • <br /> APPLICANT: City/State/Zip <br /> Owner Owners Agent Contractor <br /> ::_timignmiiiimin. <br /> Contractors Agent Tenant(must <br /> CONTRACTOR provide aletter o/consent from the owner to do work in the space) <br /> Address <br /> • �, A <br /> ii , ,-i iii i i i i m in iNI <br /> C <br /> \. 11. NE- <br /> + , :7k/CONTACT FOR PERMIT y" �� <br /> ar i.- cam <br /> BUILDING PERMIT APPLICATION Phone/E-mail je k — 1—gas, <br /> CONTRACT PRICE OF WORK <br /> Existing Use of Building <br /> Proposed Use of Building HEAT SOURCE: <br /> Building type: _Single Family Duplex TownhouseGas Electric <br /> Multi-FamilyOther <br /> T pe of project: _New Addition Commercial <br /> DESCRIPTION OF WORK(additional space provided on the aPk)r Ti. Sign Sprinkler _Demolition Chane of Use <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn �Alterafion <br /> Show Number # —Repair Type of Project: _New <br /> ()of fixtures �Ad ,._Alteration._ Repair <br /> NC—air handlin_ units Show Number(#)#)of fixtures • <br /> • <br /> IIIIIIIIIIIIIIII11111111.1111111111 Forced airs stems Toilet <br /> Bathtub <br /> Lavato wash basin) <br /> Gas fireplace Shower <br /> Gas rangeI Kitchen sink&dis•osal <br /> Clothes dryer Dishwasher <br /> Range hood Clothes washer <br /> 111111611111 <br /> Neat pum• <br /> IIIIIIIIIIIIICiri <br /> Unit heater �r Sink(selroice/barlmop/etc.) <br /> Backflowprevehter <br /> Boilerillini <br /> Refrigeration Drinkln• Fountain <br /> I Woodstove 1111.1.111111Floor drain <br /> Duct;n. Grease tra• <br /> Other • <br /> Roof drains <br /> SPRINKLER/SUPPRESSION SYSTEM Medical Gas <br /> `� Other: ;'!: _ s �. <br /> Number of Heads , <br /> Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.Ail provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granling 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 em authorized by the owner of this property to perform the work for which application is made and I comply wth the Stale Contractors Law 19.27 RCW and 296.200A WAC. <br /> o <br /> Ow Autho gent Signature 3,/" 1�i <br /> Date <br /> (Revised 3/2013) <br />