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PERMIT APPLICATIC I . <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: PROPERTY TAX#t P MI <br /> 0 3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER/14014e/ t /h.e,rAI( pct/Y Phone/E-mail <br /> Address <br /> /0,20 5 /f . 1,./ 5-e�//7!/alpvt./L. srv7GT City/State/Zip e if ,s--d 0 <br /> APPLICANT: 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 (c.."),F,7/ ;� /1C ,e7c State Lic.#/(�',17(.--77/ r Te.,y city Bus. Lic`#P <br /> Address ,�J 1 D ./ /i i s l(/ n �sy_ ✓; Phone/Email z/2� �'7" //2. <br /> ` ` = ` ` • ' CONTACT FOR PERMIT <br /> /Y 4\['f JJ Phone/E-mail 5 <br /> cam- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK %c <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building g" 4'4c�') j 5 -';, Jc.-.y Gas Electric Other_ <br /> Building type: —Single Family.--k— 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 /> l// l i t�JJ- .S zi� �C 2) �✓� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ofProject: 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 I Shower <br /> I Gas fireplace Kitchen sink&disposal <br /> . as range Dishwasher <br /> CI. es dryer \ Clothes washer <br /> Rang- ood Water heater <br /> • Exhaust -n • \Sink(service/bar/mop/etc.) <br /> Heat pump\\ Backflow preventer(inside bldg) <br /> Unit heater Un al <br /> Boiler Drin g Fountain <br /> Refrigeration Floor s -in <br /> Woodstove ! Grease tr:. <br /> Ducting ! Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYS M 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 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 /> Owner/Auth rized Agent Signature Date (Revised 4/2015) <br /> 2 <br />