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PIRNT APPUC TWUIOJ�q <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: PRO,PERIX-T # P. RM <br /> 01,C) <br /> T/ <br /> d0O 1 � i (.� <br /> LEGAL for new construction: Short Plat/subdivision n . L i— Lot No. = (attach copy of long legal description) <br /> OWNER ;J AlNV1 <br /> W . I t liJ 11 'L Phone/E-mail <br /> Address IIO"1 <br /> ( S�1 City/State/Zip <br /> APPLICANT: Owner _Owner's Agent _,Contractor _Contractor's Agent _Tenant(must provide as letter of consent from the owner to dp work In the space) <br /> CONTRACTOR JI���U� tJ Inc State Lic,# .J QC�4JN T�J�M City Bus. Lic.# <br /> AddressIu(� Spyd , <br /> Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail ��✓��������� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK61 lOQ0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of,B 'Iding c5C R Gas '4 Electric_ Other <br /> Building type: _Single Family Duplex_Townhouse _Multi-Family —Commercial <br /> Type of project: •/' New _Addition _Remodel _Repair—T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): op <br /> "Vo1I <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration_,Repair Type of Project: w New_Addn ,Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> JT 4 Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin). <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> / Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> PL t Range hood qtr 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 /> 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 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 b he 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 /> Owner/Auth 4edent Signature Date (Revised 4/20(15) <br /> �I 2- <br />