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OPERMIT APPLICATAW <br /> BUIL®ING/MECH LAICAL/PLUMBING/SIGN/SPRINKLER/DEMO ,ITION <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: _ PROPERTYTAX# PERMIT# <br /> C`i` �' -2�(2LaC ✓? (c 1& <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER / a LJ2rZU j Phone/E-mail 44 <br /> r <br /> Addresst�rJ� l � � � tL" �� ;�f'( „City/State/Zip <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor's Agent —Tenant(must provide a leller of consent from the owner to dp work In the space) <br /> CONTRACTOR ( 1/f 2 ���S�y�2C(�/C^'�'l� State Lic.# K/M City Bus. Lipc.#Q/�l <br /> '1 mail <br /> Address Pbh r`�_C� � �✓ if L�•�. � +M�1/+'. l C-�1' r u " 3 Phone/E <br /> � _ . <br /> TENANT BU51NESS NAMECQ[JTACT FOR PERMIT z 4C `) �$ <br /> .�C rCt l 5L rnAge-, J <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK J <br /> Fisting 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 v, Remodel _Repair T.1._Sign_Spdnkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> U� ��a�� � � inn`n1 <br /> IOG t0,/� l d ,k <br /> ��. 5 h S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ,_New_Addn _Alteration,_Repair Type of Project: _,New_Addn __-Alteration rRepair <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 Backflovv 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 specifie rein 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 ;Jzed by t e ownerpfthisp top orm the work f:77T <br /> 1, t* maind 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> yr/ ed Agent 5' _ (Revised 4/2015) <br /> �t�7, <br />