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?ERM : PPL CC. AT9 i] <br /> BUIL®oNG/MECHaNMAL/PLUMBING/SIGN/SPR9 KLLER/DE OLIT QN <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 PERMIT*ADDRESS: PROPERTY TAX# f' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER 7-;,". -- 3 c',_c lam. — Phone/E-mail ‘..,',i.-,-7 >c..) t ;�3 <br /> Address i; ,,,„..-:•->_ ,,,/,_,/ y— -o-• City/State/Zip , - - e..�/,fi 9. mac=- _ . <br /> sa __ <br /> APPLICANT: ! Owner Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR ._)a�l2 -e..--1--- <br /> c-- 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 '''.1-3-0C...“:-',------- --:j <br /> Existing Use of Building ,.-/Z HEAT SOURCE: <br /> Proposed Use of Building ,.-_:.->e,-.--.,=/27 '— Gas_ Electric Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: _NewAddition —Remodel Repair—T.I. Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORk‘(odditional space provided on the back): ,..-7,...,_._is- C_:_ci 4.,' ,>-^ <br /> Y <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 /> Water heater 1 Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer <br /> 1 Range hood Water heater <br /> Exhaust fan 1 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 1 Grease trap <br /> Ducting 1 Roof drains <br /> Other Medical Gas <br /> ,-SPRINKLER I SUPPRIESSI���N SYSTEM / • <br /> I Other: <br /> INumber 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 application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> :77.-- <br /> -� l 1?.?.7 --- <br /> Owner/Authorized Agent Date (Revised 4/2015) <br /> OwnerlAuthorized Agent Signature <br /> I/(Z <br />