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PERMIT APPLICATIGivi <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <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: n PROPERTY TAX# PERMIT# <br /> C. 15 0-7-oo( <br /> LEGAL for new/ construction:/sShort.Pllat/subdivisiion Lew f Lot No. (attach copy of lon <br /> g legal description) I, <br /> OWNER Iv 1 ti1e51/� 1 LM ty' k l�V l LD {J 1'L Phone/E-mail 0,25:512.44-03401/jai VlC(5,I :-:Ae oc(ure-`O I1Jti2S M4'x <br /> Address-Pp&,x [Z(7 c 1 City/State/Zip ,14th GV ee I- i � A eiWe' 2-- <br /> APPLICANT: X 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 �t jn ,�lA({', 4--1()f()foe S State Lic.# t G N A H l I7KECity Bus, Lic.# <br /> Address t i D �� t V <br /> all L, I Mt & ) wp ‘)"U hyl' <br /> Phone/Email )r) 1051rayl/n, ,�Q,-Yt6t'I'IC',S,I'1o.�1 <br /> I tNANT SINES NAME CONTACT FOR PERMIT ` <br /> J-6h n I V't in_S-tZi( h (435) a'-t-4-0'5 <br /> Phone/E-mail ci\r\ 'a11.)n ,l e-Inu vies net <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK :5Co7, 07(() <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas V- 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 /> Bac( 6 RBI 5C)(0 -°CMZ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: v/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 /> 2- Forced air systems 4- 1 Bathtub <br /> Gas piping g I Lavatory (wash basin) <br /> I Water heater Z ; Shower • <br /> _Z I Gas fireplace 2 Kitchen sink&disposal <br /> 2 Gas range 2 Dishwasher <br /> 2 Clothes dryer 2_ Clothes washer <br /> Range hood Water heater <br /> I t) Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Z Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> L Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> I Ducting I Roof drains <br /> 1 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 authoriz/ by the owner of .roperty to perform the work for which pplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 7 /S /,S <br /> Owner/ uthorized A.en S'. ature Date (Revised 4/2015) <br />