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• <br /> PERMIT AP t* LICEi TIO <br /> BUILDING/MECHANICAL/PLUMBING/SINN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERM! <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8f15:9 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# #/� <br /> L3 (G (2:1-14 6-11,..6-11,...6d-z <br /> tIIRMIT <br /> ''�(3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT: Owner Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR UP 4 C a for ' ri,S' State Lic.# OP}--s R.t_'1 K L;To • city Bus. Lic.#OS-Lo 15- <br /> Address 2Z Z 3 �� 5 o S E.. p to Y/fi--La 0, •• kro cIci 3-1 2- Phone/Email Z' .-) L4 (i - 0`� i' 3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> pays Pt,-1,f cIRL5 ( I-vil3 <br /> Phone/E-mail • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK -7 3) /-1 , 5 7 <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 _Repair—T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): • <br /> 0 V t r2 LY}y 12 op i' wN <br /> : 1- - 1`1 P0 <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 /> NC–air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin). <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I 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 I Grease trap <br /> Ducting I 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 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 perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (/G 1,-, /�v vwl,— l <br /> Owner/Authorized Agent Signature Date '��� Qj („b' (Revised 4/2015) <br /> • C a <br />