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1 I�I\I�1� 1 n1 � I��vn ��v�� <br />BUILDING/MEC�NICAL/PLUMBINGISIGNI�INKLER/DEMOLiTION <br />CITY OF EVERETT PERM{T SE �ES � <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: �_= -1 -L' PROPERTYTAX # F'tKm� � s� <br />� �-> > � � ►� �' � aoy5�'I� ��l�d dnv V'�'1 i�S t�c' C� � <br />LEGAL for new construction: Short Platlsubdivision lot No.• (attach copy of long legal description) <br />OWNER �����/i f7ol�f//�ji f�1L�Ty4%Z Phone/E-mail �G .�Z�O , � � � <br />Address�4 ,(Sd� /,�� City/Stat�p ����%T y/T� Q G 0� '' <br />APPLICANT:,�, Owner _ Owner's Agent _ Contractor _ Contractors Agent _ Tenant �mu5� P�taa a ianar or ea,sent trom wa owner eo do "�oec in u+e sv <br />CONTRACTOR �ND�aAi'C State Lic. #���� �� �O i Z City Bus. Lic. # vZ I�?��� <br />lddress Phone/Email <br />fENANT BUSINESS NAME CONTACT FOR PERMIT ���.�/ ��C"'�T^,/�"` <br />V�rl�d/ �/ ��"'� Phone/E-mail � � � �7 E7 �� ��r � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��iDO, � <br />Existing Use of Building J'�/�� HEAT SOURCE: <br />Proposed Use of Building �/�/`� � Gas Electric <br />Building type: _ Single Family _ Duplex Townhouse _ Multi-Famity _ Commercial <br />T��p� of project� New Addit(on .s� Remodel Repair T I Siq�1 Sprinkler Demolition_Cha� <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�'� �Gtc� c�. -���� r� � ; <br />P <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number # of flxtures <br />AIC — air handlin units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaust fan <br />Heat um <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />Ductin • <br />Other <br />SPRINKLER ! SUPPRESSION SYSTEM <br />Number of Heads <br />Other <br />of Use <br />PLUMBiNG PERMIT APPLICATION <br />of ProJect: _New _Addn _Alteration _Repair <br />Show lJumber (#) of Rxtuies <br />i one� <br />Bathtub <br />Lavatory (wash I <br />Shower <br />Kitchen sink 8 d <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/b� <br />Backflow preve <br />Urinal <br />Drinking Fount� <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other. <br />Other. <br />I hereby csrtify that I have read and axamfned this appifcapon and know the same to be trve and correct. All provislons oi laws and ordinances goveming this type of work will be cor <br />with whelher specMi�d erein or not. The gra�ting of a pertnit does not presume to gNe authorSty to vblate or cancei the provislon ot any other state or local Iaw regulallng constructl <br />That I am authorize b e own r of ihis property to perform the work for which applfcaUon Is made and 1 compy wlth the State Contractors Law 18.27 RCW and 298.200A WAC. <br />,- t � __ �' ' r j� <br />OwnerlAuthorized Agent Signature � Date (Revlsed 4/2015) <br />