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• • <br /> • <br /> PERMIT APPLICATION <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:``://• ��Ar 1/ f� 47QAi PROPERTY <br /> 7�3ts�3.44-r� Pui�to-0 1() <br /> LEGAL for new construction: Short Plat/subdivision _ t No. (attach copy of long legal description) <br /> OWNER( 40,_ 4e3)1_,,i7 f, f ,®/J Phone/E-mail ' l� I /74- 7,47/ <br /> Address '" City/State/Zip \ <br /> APPLICANT: Owner 1� Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to d, ),� <br /> CONTRACTOR a State Lic.# GC9IV�A t ��# ti t <br /> / Z � - <br /> Address z 177,( j7 �5.. A LJ isi Phone/Email ,<� <br /> T �©�`��/�-�- CONTACT FOR PERMIT /�.J / �, ( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORD 124 • 70 <br /> Existing Use of Building i 71 �([ HEAT SOURCE: <br /> Proposed Use of Byilding Gat Electric Other <br /> Building type: /Si le 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 /> e"-O vc /7.'4: �, �G -nC. <br /> WI-rff et 7--r4q(ep 6° -rp 4A ,�- <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 'j Toilet'✓ <br /> t Forced air systems r _ Bathtub v <br /> 'j Gas piping Lavatory(wash basin)✓ <br /> Water heater Shower✓ <br /> A Gas fireplace q' v Kitchen sink&disposal ' <br /> j Gas range Dishwasher <br /> Clothes dryer Clothes washers/ <br /> Range hood ater heater <br /> k c Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <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 comp <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 th' erty 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 /> 7 Z eD /7 <br /> Owner/ oriz Ag Signature Date ) (Revised 9/2014 <br /> p <br />