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SIPERMIT APPLICATIlk <br /> BUILDINGIMECHANICAL/PLUMSING/SIGN/SPRINKLER ®EMOLMON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wvvw.everettwa.org <br /> SITE ADQRESS: / PROPERTYTAX# MIT# r <br /> 11110b 5C 41)lcp JVAJ <br /> LEGAL for new construction: Short Plat/subdivision f Lot No. (attach c`o�py of Ibng legal description) <br /> OWNER -I �GI.l yt �. �l.jll li (S 6�� �GtIL� �.'i S Phone/E-mail 4, 5-- -3q6—C, -71Z <br /> Address PL�� pv City/State/Zip L(ej,ferjr uo oto <br /> APPLICANT:—Owner _Owner's Agent ,$ Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to Op work In the space) <br /> CONTRACTOR F.UC C,PC)=-tA --JT-X,-6 15&�4L z State Lic.# LVEA295S -2D l City Bus, Lic.# GC% 1`1�T7 <br /> Address -0J AG-1rL(- k)l✓, it�1 riR T G(.,-A q92—,)1 Phone/Email 4 Zj— -2-G2-3 <br /> CONTACT FOR PERMIT <br /> I //I 42-5-?7� - r! <br /> �r`�`�` �l Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ,;zl.•�`i <br /> Existing Use of Building C� t-9l�� /L't HEAT SOURCE: <br /> Proposed Use of Buildings � Iz' Gas it Electric_ Other <br /> Building type: Single Family _Duplex—Townhouse _Multi-Family Commercial <br /> Type of project:--New —Addition _Remodel -I-Repair—T.I._Sign_Sprinkler—Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration>LRepair 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 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 orized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> (Revised 4/20 ) <br /> Q"W/Authorized a Signature Date <br />