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PERNT APPUCA kl ION <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: PROPERTY TAX# PERMI # <br /> 3-7->i culls Av17 GV �' © tel 0 Z 100 �1 Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER y a v+ _e- Phone/E-mail <br /> Address 3-73( City/State/Zip evevdr W.4 <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 �1/�������� ����� �&Zs <br /> it - State Lic.# �����C�Z2�'l City Bus. Lic.# Ov <br /> C "7�lSzj <br /> Address k-2,D N-[r�I` N- )C-. K x/ 12 ( I(,t� q92-01 Phone/Email Z� Z�j`Z 3(I <br /> TE1qANT BUSINESS 010F CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK D 0 <br /> Existing Use of Building N' e t4AIV66' - HEAT SOURCE: <br /> e <br /> Proposed Use of BuildingD Ct� � 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 /> i2q�a✓ I/LqDi'a-cE �STtoA <br /> C-•a,,�-zu� ,°tisPr�� 'ice r3v�o���G <br /> o- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ,_New_Addn _Alteration_X 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 Ore venter(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I DuctingRoof 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 Lamm thorized 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 /> V� <br /> Revlse' <br /> t2 Zf 1 <br /> �pgr/Authori Signature / / Yate d4/2575) <br />