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r <br /> tERMIT APPLICATICOR <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 ADDRFcc• PROPERTY <br /> . 2gi ._syIIne : p;r Y TAX# P I <br /> I DORTSZD3Dt�ao " oro �no5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER 4 4 P 144 1 d 3 1-1.-C--/_..(� Phone/E-mail 4/2, 7.5"2, 8 ZK(PS #044/44 Wei AV,10• 4.C.0•'' <br /> Address IZS ,5 t�4 j d 24„, Sr -.. ' R_ City/State/Zip L w�� ,51.e././42.-.4 4/14- 9g 2-SY <br /> APPLICANT:X Owner ±Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to tip work In the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> O CONTACT FOR PE <br /> 14111 <br /> O`� ( sq-we r 11 6 .,gyp /4 15—s� S Z.is/Coo-5— <br /> ' <br /> ?8T V 1r''�t��l� hone/E mail Pa`v L 1 q/-q 9M., . cA,r'"1 <br /> BUILDING PERMIT APPLICAT ON \ CONTRACT PRICE OF WORK-"K`ic-000 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas 1r Electric J(, Other <br /> Building type: .Single Family _Duplex_Townhouse _Multi-Family _Commercial // �' <br /> Type of project: 'i( New Addition _Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK <br /> ( space additional provided on the back): <br /> NIz w s c f -.. 19 tv.� t , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:'_New_Addn _Alteration_Repair Type of Project: 7Y,LNew_Addn Alteration^Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units Toilet <br /> �,v% j Forced air systems 1 Bathtub <br /> t <br /> r' ) ix Gas piping LI Lavatory(wash basin) <br /> S Water heater Shower <br /> I - . Gas fireplace ()/2yL <br /> I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer J Clothes washer <br /> Range hood -AV" Water heater <br /> LI 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 wheth= specified he ein 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 au h• 1-• 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 /> I (g/Li 1 t 5—, <br /> Owner!. • •rized Agent Signature Date (Revised 4/2015) <br /> • <br /> tI2...._, <br />