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Feb. 22. 2016 9: 55AM No. 2016 P. 2 <br /> PERMIT APPLICATION <br /> BUILD1NG/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Si, Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX, R P RMIT# <br /> 'j)(/)../ z..U. 4"-a-< Ori�� c�rs� t l�tf�;t• �• <br /> • J <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER T.-40A Gak_tp.irk Phone/E-mail vile �ker(iI <br /> Address -7)1,2,1 -7 1.06...1_ t. ._ L \+- City/Stale/Zip t:{rte!I'' l t:1,c �l i 7:%t <br /> APPLICANT: Owner Owner's Agent � Contractor . Contractor's Agent Tenant(must provide abear otconsent iron,Ina~Cc todowork irspace) <br /> CONTRACTOR () e*) \- ' (� -�;\3 State Lic.U ()' t-A cze City Bus.Lic.# <br /> Address 9)4 Cel 4/Z4 AtVe-- Phone/Email <br /> Ui`7i• 7.C7.--.14C;)••• <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phoou✓E-mall Loi,-L� •- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t r'_X j_;tcC <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Othur <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel . Repair T.I.,Sign_Sprinkler_Domolition_Chango of Use <br /> DESCRIPTION OF WORK(oddlrtonal space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _New_Addn' Alteration_Repair Type of Project: New_Addn _Alteration_Repair <br /> Show Number(a)of fixtures Show Number(#)of fixtOres <br /> A/C—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 /> • <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> ! Exhaust fan Sink(service/bar/mop/etc.) <br /> 1 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 toothy certify that t have read and examined thla application and know the sumo to be true and onno:I,Al provisions of kiws and old'prdm:ers unveynirrp this type or work wil be cowl <br /> with whether epacllled herein or not.I he wanting of a permit does not prose=to picas:slam ily to viomle Or Ggaxel the piOvi:ritm of day other stale or local law reQulaIav construction <br /> That euthorizod by the owner of Oris property to podia in Ike work for which spouts:tn le made and I comply with the Slate Contractors Law 18.27 ItCW and 2UU.200A WAC. <br /> 74?)Zeilit) <br /> OWnr orfzed Agent Signature DaLA (Revised 9/2014) <br />