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PERMIT APPLICATIUI <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: i �j PROPERTY TAX# PERMIT# <br /> 530,w 5)i 6/ <br /> '� QY) 4) d• ,k G 15 07-0000 <br /> LEGAL for KA <br /> construction:/st , Short Pllat/subidivision �/ 1 Lot No. (attach copy of'Ong legal description) I <br /> OWNER N 1 R`-s1/t V l LNl nok Y ?'.Two--o Phone/E-mail 0255--12).44 /fii ii(9,1 �1ct W C-AU(1 .5 wirL <br /> Address-Pp')( E�1 I� V City/State/Zip MIR Cv k—1 JIA e "O2— <br /> APPLICANT: Xti Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dpwork In the space) <br /> CONTRACTOR 5Titvt(e T-1Dm t S State Lic.# I G N A H *9 11KECity Bus, Lic.# <br /> �1 n )� )'t{4 °';-2“1 <br /> s �i <br /> Address 0 } 12( I j �/v�:1 ��J � Phone/Email JPIAin,� J"Stl t;ien.±Lq 410ille, , <br /> . . . :1 . 1 . r CONTACT FOR PERMIT �:,� <br /> 37)h n I VI i,L5-i7c C V1 ('&) ,9--4-.-I---C)9-1- <br /> . <br /> Phone/E-mail JChr\ St5nit e`L'mt 1e.s ne- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .5C7, 07(.o <br /> Existing Use of Building HEAT SOURCE: • <br /> Proposed Use of Building Gas V Electric Other <br /> Building type: Single Family v/ 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 /> aS( :II. RBI 5°& -°0z <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 /> NC–air handling units (� Toilet <br /> Forced air systems A- Bathtub <br /> Gas piping g' Lavatory (wash basin) <br /> Water heater Z Shower <br /> Z Gas fireplace Z Kitchen sink&disposal <br /> •-- Gas range 2 Dishwasher <br /> 1.-- Clothes dryer - Clothes washer <br /> 7 I Range hood Water heater <br /> i L� 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 /> I 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 authorizil 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 /> /s5 Revised 4/2015) <br /> Owner uthorizedA•en S'. ature / Date <br /> ki Z <br />