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���n�i�r �����c��rsc�� <br />BIJILDIId�If�IiECHi4NICAL/PL�N�BING/SIGN/SPRIf�I��ER/DE�tI�L,IT'a�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 />e �505 - �sr <br />ITE ADDRESS: PROPERTY TAX # P MIT # <br />�3�1 '�tZ��l�l►.Ji�� � od439o��Cot,ao �f ��� g`�(`� <br />�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />PhonelE-mail <br />Iress 'S$ 3�Q �UF�C�� �C�,r�. W►'1�-� IGity/5tate/Zip <br />PLICANT: Owner _ Owner's Agent �:, CofltfactOf _ COfltfaCtOf'S AgEllt _ Te�Bflt (must provida a letler of consent from the owner to dp work In Ihe space) <br />CONTRACTOR <br />dress �gtb L��o��. P'l 'I.iFi �i <br />�upe, t,NDP.�S <br />BUILDING PERMIT APPLICATION <br />Stafe Lic. # <br />E� <br />City Bus. Lic. # <br />Phone/Email ��. s� • � �Q'J <br />R PERMIT K�,� ��� �H S <br />Phone/E-mail �a5- S �g- �` <br />CONTRACT PRICE OF WORK <br />Existing Use of Building 'v�' ZL)Q(�(�� <br />Proposed Use of Building �j4F'Fi Gas <br />Building type: ,_ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New _ Addition _ Remodel _ Repair � T.I. � Sign _Sprinkler _Dem� <br />DESCRIPTION OF WORK (additional space provided on the back): <br />��M4ut� �X�Si1wG ��yt �CG(+�sl.��Oc4`zL iJc:tt��h�.�/;�c.3�tr�c«- • <br />r c� � �-$5 �Ce.s,s � S-r►4N+� , _ <br />Type of Project: _New _Addn _Atteration _Repair <br />Show Num6er (#) of fixfures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Unit heater <br />Boiler <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />0 <br />HEAT SOURCE; <br />Electric <br />on Chanae of Use <br />AZ� �lumb ��� <br />�• <br />PLUMBI G PER1N'T'•APPLICATI <br />� of Project: New Addn ,._Alteration _Repair <br />` "'' ShGw Num er`(#J of fixfures <br />I l'oilet <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposs <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/ <br />Backflow prevente� (in <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 />wiih 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 pertorm the work for which application is made and I comply with the State Contraciors Law 18.27 RCW and 296.200A WAC. <br />���, �d ./l,� s �_ ��� �— <br />OwnerlAuthorized Agent Signature ate (Revised 4/2015) <br />l�Z <br />