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PERMIT APPLIC,AT Iu 1 <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: PROPERTYT # PERMIT# <br /> 7y,Cr �-.2 Sr S-;.4-. Oos 30/0.2oo .:0611! A /) - _ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER .27.+Vw�e. '1 .t _ <br /> f (_, L. U Phone/E-mail t?' , 3,3jr-3 J / N V //4"i"tr <br /> Address PO ` )( L.5---47 city/State/Zip Joif e1j/T um— ff`?Zc'( <br /> APPLICANT: c''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 0 State Lic.# City Bus. Lic.# <br /> Address • Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 21 606 <br /> ExistingUse of BuildingAl HEAT SOURCE: <br /> CC <br /> Proposed Use of Building --.)"` J Gas_ Electric Other_ <br /> Building type: N Single Family Duplex ownhouse _Multi-Family Commercial <br /> Type of project: _New Addition _Remodel Repair—T.I._Sign_Sprinkler_Demolition_Change f Use <br /> DESCRIPTION OF WORK(additional ace provided o the back): _• 4',"--e,- >��� <br /> n / /i �' ,, .eJ� : -tet rJ (✓0.fs J <br /> t�i— rZ `7r ,e c� , ' ' ft lam!'K - ra'vfT,. <br /> MECHANICAL PERMIT APPLICATION PLUMBINGPERMIT APPLICATION <br /> Type of Project: ALNew Addn _Alteration_Repair Type of Project: New V/Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 1 Toilet <br /> Forced air systems Bathtub <br /> Gas piping I 1 Lavatory(wash basin) •. <br /> 1 I 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 /> 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 I 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 e ted 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 a red by the o ner of this property to perform the work for r ich-pplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> d/ <br /> �) aca / <br /> O er/Authoriz-• • • Signature Date (Revised 4/2015) <br /> \I2, <br />