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• <br /> PERMIT APP UCATIU1 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRI KLER/DEMOLIT ON <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: PROPERTY TAX## PERM,IT <br /> -�- 0 � i f �C-) A-,, IV Q02 b 1060 5 v (/l1JO, -001 <br /> 7• t`'�- 9 0-Z-68 Lot No. (attach copy of long legal description) <br /> LEGAL for new construction: Short Plat/subdi tslor{ <br /> OWNER R S 'Pl✓_/ '70 I efSex_ Phone/E-mail <br /> Address i - •-L' 6- (lila lA Ptt City/State/Zip <br /> 1,-L-�43 t^ � �g �. <br /> �t <br /> APPLICANT: Owner Owner's Agent / <br /> Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR £6 URA ICI State L-ic.# \NE- (i),1 V(.• ,U0ity Bus. Lic.# (a D�'/}{iS� • <br /> inAK <br /> Address • <br /> Phone mail � 2fDtP--11 5-4D32_ <br /> CONTACT FQR PERMIT <br /> 0 A Aft, C.? t n v I/2 Ajun C"1Gi✓v t dl <br /> Phone/E-mail 4 l3 Cd q�oi t- i-s. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f 6, • , 6Zt�. <br /> Existing Use of Building 5 I z---1' L .....et.�.. t HEAT SOURCE: <br /> Proposed Use of Building "A V1 it- t�1�t( .-7 t e Gas_ Electric Other <br /> Building type: '/Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: New Ir Addition —Remodel Repair—T.1._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): • <br /> I 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 I 1 Toilet <br /> Forced air systems Bathtub <br /> Gas piping / Lavatory(wash basin). <br /> Water heater i I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> I " Exhaust fan I Sink(service/bar/mop/etc.) . <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> BoilerDrinking Fountain <br /> Refrigeration Floor drain _ <br /> Woodstove ! Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> I.--- SPRINKLER /SUPPRESSION SYSTEM Other: <br /> Number of Heads I 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 /> t z0r. <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />