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"PERMIT APPLICATI01 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SP RINKLER/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 MIT# <br /> 0ZLEG - <br /> f U vGctC�r.✓ r 150 n02.- <br /> LEGAL <br /> AL for new construction: Short Plat/subdivision ( f ��`�t' if�S�tf Lot No. (attach copy of long legal description) <br /> OWNER t' J I`Jt Tl P( 4 ' 0E V. L (-.,C.. Phone/E-mail �S (,lc S•(ai,�. `y2S T f3 <br /> Ut - to ucc> <br /> Address 1 2 U I v' Eve ve (n/cc S-k (ft City/State/Zip �t�N�,–K ",JL4 l s Z(w <br /> APPLICANT: Owner _Owner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work in the space) <br /> CONTRACTOR L L State Lic.# City Bus. Lic.#042 113 <br /> Address Phone/Email <br /> 7T--17NT BUSINESS NAME 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: _✓ Single Family _Duplex_Townhouse _Multi-Family •_Commercial <br /> Type of project: New _Addition Remodel _Repair_T.I._Sign_Sprinkler V1 Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Z),/w� go A&e 13&0 <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 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 ting 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 or' by the owner of t s pr party 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 /> 4/5- <br /> Ow er/Authorized AgentSr /ture Date (Revised 412015) <br /> V2 <br />