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OPERMIT APPLICATI01 <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# P R IT# <br /> F 2 56 T Vo etzl -1 - oo <br /> LEGAL for <br /> rr9new construction: Short Plat/subdivision 4 L/-11,16 e 1;ki Lot No. (attach copy of long legal description) <br /> OWNER Lt/ �Q �,V)tUF, n�(r� �Ua, L L), Phone/E-mail j/JGLk: �" S��t �ti �cw�lil. laves L453 z8�� <br /> Address Z U &A) �Ve I/( Jbt bItt ttl141f JC ity/State/Zip VnVe W n t- <br /> APPLICANT:25zwner _Owner's Agent _Contractor —Contractor's Agent _Tenant(must providefa letter of consent from the owner to dp work In the space) <br /> CONTRACTOR L C- State Lic.# City Bus. Lic.# L4 iI 1 <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: N/ Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition _Remodel _Repair_T.I._Sign_Sprinklery/Demolition —Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Vl0wve, l �jv5i ►i-eSS �v1 �� IhS XZ- <br /> Lf <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 /> I Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and a ned 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 no.Th 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 thorized by the ow ne oft s 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 /> Ow r/Authorized Agent 7 <br /> ignature Date (Revised 4/2 15) <br /> R Z <br />