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pE 1`iAT / PPLOC/ T9 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <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: <br /> 1 PROPERTY TAX# pIRMIT## <br /> -DO,' Nler„�00�• : , ' C_G/' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. , (attach copy of long legal description) <br /> OWNER WA�/l. "llat h. la l CSD { l 1...W.,5)-2.44-034.01 Phone/E-mall fl • <br /> /yin VI @ -JriG( rC 6i'NtG3 <br /> tfig <br /> 2APPLAddress'PO -24-7 1,, _ City/State/Zip Mil. .e — (k) e .0 .2.- . <br /> _ <br /> APPLICANT: <br /> ICANT: 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 -j l g/ioe �-I ,'le State Lic.# I, • (--- *91 City Bus. Lic.# <br /> Address Q 6 1211 i ;&e,4 W A 6 gb Phone/Email )A s A fro,---tuirn ,L, <br /> . . . :1 . CONTACT FOR PERMIT <br /> Jc)h11 IvtI,t.5-izzCL' (,z0 ) �a.,.-+-1 (D 1 <br /> ,,5 <br /> Phone/E-mail jc hYt (A Sl IrifA/1ihJ1��VL���S° <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /7_0630—_ <br /> • <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 /> CCr15 t,,, �/\ a 0 , e3‘-‘,--'Rock- Block. 8e-k-in , U...1 ,1 j • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: LNew_Adds .__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 pipingLavatory(wash basin), <br /> I Water heater TI Shower <br /> • <br /> —7-1 Gas fireplace Kitchen sink&disposal <br /> —_I 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 /> Ducting <br /> 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 speclt ed 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 lam autho,Iii by the owner of roperty to perform the work for`k'hr� aoolic tion is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ..' C 7 ;1 <br /> /- ye,< Z5 . ..t:)\ <br /> � D (Revised 4/2015) <br /> Owner/ uthorized A en Si fixture Date ' /! <br /> �� q <br /> 2- <br />