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PERMIT APPUICATIC .- <br /> BUILDING/MECHANICAL/PLUIVMBING/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: PROPERTY TAX# PF,RMIT# <br /> t 0 V* 1 q ri"` ke E Site. I' It ! (0-00,7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Lo 5J Slo e_ € I i L Phone/E-mail <br /> • <br /> (42.0Z6--Z 5 14dO <br /> Address ?(.) t 13q 3 v 14 MCity/State/Zip s� U4- ) ©o7 <br /> U `, <br /> • <br /> APPLICANT:_Owner _Owner's Agent _Contractor Cont actoc'S A ent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> E.vC�fY la <br /> / 7 / // �r�,I <br /> CONTRACTOR )(-)Y1Ci‘�G L L . 10 <br /> � 1a0c.# ( Ove 3l^, - €7.4y-Bus. Lic.# uIIV j C° lI <br /> Address 5j S' 5. 39I� - �, N z�,r1 W • ctg©° Phone/Email(2 53)Z 2c( go, y 3 <br /> 0 r�, • , :1 , , • r CONTACT FOR PERMIT ee�� ff ff� ^,t <br /> \(AV1i Nfa is avec! S P`� Phone/E-mail(-2�3)023,2-g 1 Q`(la('t' nn(n�� VW` (.0 <br /> BUILDING PERMIT APPLICATIONCONTRACT PRICE OF WORK IkSOO- <br /> Existing Use of Building 511,1)t 1 C.. \-e_g-- HEAT SOURCE: <br /> Proposed Use of Building/AZ r t r o ((\P& Sa w`e Gas Electric Other <br /> Building type: Single Family Duplex_Townhouse Multi-Family K Commercial <br /> Type of project: _New Addition ,S` Remodel _Repair_T.I. Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK --•itional space provided on the back): • <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 /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> • Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> • Range hood Water heater <br /> • Exhaust fan • Sink(service/bar/mop/etc.) <br /> L Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler ( Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove j Grease trap <br /> I Ducting I Roof drains <br /> Other Medical Gas l <br /> SPRINKLER / SUPPRESSION SYSTEM ,T3Other: Spa Peet c tce Lkcti!•' <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 ayt on d t 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 /> Owner,? uthorized Agent Signature Date (Revised 4/2015) <br />