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*PERMIT APPUCATAN <br /> BUILDING/MECHANICAUPLUM.BING/SIGN/SP RINKLER/DEMOL,ITION <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: A PROPERTY TAX# PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach Copy of long legal description)' l <br /> OWNER �jof M L C Phone/E-mail <br /> �(�p�� <br /> Address - �" f!�f> Fjc. qf- l l� ity/State/Zip t7 1. (`S <br /> APPLICANT: Owner _Owner'ss A,g\entn_Contractor _Contractor's Agent _Tenant(must provide as letter of consent from the owner to dp work In the space) <br /> ROM- <br /> CONTRACTOR a—`(Q�� VJJVS�IZ CST I��,,w State Lic,# RQCy�S City Bus. Lic. <br /> Address _ - t�-� Q�%' c�' {3 Phone/Email <br /> CONTACT FOR PERMIT <br /> [;�61I K�aM� 2.0 <br /> Phone/E-mail 4A I LCS ('Zo <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK <br /> Existing Use of Building 'j 1 HEAT SOURCE: <br /> Proposed Use of Building g.:v3-- P-- I Gas_ Electric_ Other <br /> Building type: Single 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 /> P1 o Uk6l au- <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 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 /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> 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 /> I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I 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 s ecified 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 a oriied by the owner9f 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 /> &AV — <br /> wner/Authorize gent Signat Date (Revised 4/2015) <br /> O <br />