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OPERMIT �. PPUCAT0oe <br /> BUIL DING/MECHANICAL/PLUMBINGISION/SPRINKLER/DEMO ,ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., .Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereftwa.org <br /> SITE ADDRESS. 1 _ a_..{ A PROPERTY TAX# P RMIT# <br /> 10-6191 <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of Ibng legal description) <br /> OWNER ��US�I\U� Phone/E-mail L-A-tU (���p�-�► !\ <br /> Address j .#� City/state/zip � <br /> APPLICANT: Owner _Owner's Agent 1 Contractor Contractor's Agent _Tenant(must provide a letler of consent from the owner to Op work In the spacer) <br /> CONTRACTOR V-"' `SAVV LA t State LIG.#NY-CkO(?t\-L City Bus. Lic.# <br /> Address '4G ,D -l 0� \ A �' , �YUX`lJ \S� C l' Lq 0 Phone/Email lZ�l y V,­A <br /> TENANT BUSINE55 NAM- CONTACT FOR PERMIT ( �-Lc:� ^ t5 u <br /> I <br /> Phone/E-mail �Y ej^ t e« � `\ �``-Av,, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � "1U <br /> Existing 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 _Remodel Z Repair_T.1._Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <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 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 I 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 by the own of this property to perform the work for which application is made and I comply with the State Contractors Law 113.27 RCw and 296.200A WAC. <br /> p L' <br /> e ate (Revised 4/2015) <br /> Ow er/Authorize Agent Signat <br /> 1� 3 <br />