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18PERNT APPUCAT16*dl <br /> B1 ILDING/REGI AI \TICAL/PLUMBING/SIGN/SPRINT LER/DEMOLITI®N <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# PERMIT# <br /> 5'112• Delaware Aye • �oyio2oodo4 Do �I � b� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER 84-6f1f V0111de0W1 f Phone/E-mail 7.0(0JSI $018 breq.%1agfrj, IfIS 3#1.)J <br /> Address 512 �e)atJa['e Ave City/State/Zip EYefe,l 5,92,03 <br /> M <br /> APPLICANT:A—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 State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> bre nt <br /> Phone/E-mail rl a11dg& , aM. I•Gory <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKby(i�C(�� <br /> Existing Use of Building Res 18 eo f i a) HEAT SOURCE:pp <br /> Proposed Use of Building h e3 tCL4A tia] Gas Electric_ Other <br /> Building type: X Single Family _Duplex_Townhouse —Multi-Family _Commercial <br /> Type of project: _New _&Addition -Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DE,§CRIPTION OF WORK(additional sAace provided on the back): <br /> t 5t�f �eQ�'ood) 1Bai'h tJddi�-►dn 00-5g) wt <br /> "Of, Sid��►y �nafcl�l <br /> exislrtAIn hOVSe,. Enc.loSG e�cis�l'neoJ��ed beeeteLaa 0000 Loj t, Sidigt <br /> �inislne.S �o �af� txisfin ho�s� <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 heaterA Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting Roof drains <br /> e.r v 'tf ! Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads el M.t Other: 15 O — 00 <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 authorized 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 /> Vb\J ,oQ� - g JZI JI s <br /> Owner/Authorized Agent Signature Pate (Revised 4/2015) <br /> IL <br /> r <br />