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0 0 <br /> PERMIT APPLICATION <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 S: CZC - - AX N <br /> RMIT <br /> LEGAL for new construction Short Platisubdivision— Lot No_ (attach copy of long legal description) <br /> OWNER ��ZAA Phon("'E-rnajl 4 M9 �,k L4 �A� <br /> Addressi city'state/zip �V?Iiireltr <br /> APPLICANT: Owner Owners Agent 'V,.45ontractor Cortractor's Agent , Tenant I r ma'­­to u. 11 <br /> ............. <br /> CONTRACTOR ?,,LiqCV- Lt L)N �4 VA State Lic. 9 6-11-1—L-114 WY Lie.# <br /> I <br /> Address(')204 N�- Qt,'O� "�4-N Kit4-l"k/V *0b4lPhone/Errail L4-- -34 4-1t­ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Pnone!E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE <br /> Proposed Use of Building GasZ Fiecmc Other <br /> Building type: %0(Single F Duplex_Townhouse _Multi-Family Commercial <br /> Type of project. New Addition Remodel Repair T,I, Sign Sprinkler—Demolition_Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back)i <br /> � T/A L—.L L,,F-- U ND)( z/,z -rD Q <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 iiilif)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas pipinq 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(servicelbariniopietc <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trae <br /> Ducting <br /> Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Other <br /> Number of Heads Other <br /> I he.rtiby certify that I have.read and exammed th,sapp,ication and know the same to be hue and coired All provisions of laws and ordinances governing this type of wok mi be cOnIP <br /> wfin,whether Specified herein or not.The granting of a penult does not presume to give"honty to violate or cancel the provision of any other state or foral iaw eguluting construction <br /> That I art n authorized try in owner of this property to perform the wort rot which app is made and I comply with the sidle Contractors Law I it 27 RCW and 206 200A WAC <br /> ; 1 -712-0 15 <br /> Owner),fr <br /> -'?�AA'6nt signature Date (Revised 412015) <br />