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PNTAPPLCATUN <br /> • <br /> BUIL®INN/MECHANIICAL/PLUM INN/SIGN/SPRI KLErgDEMOLI` ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> PROPERTYTAX# PERMIT# <br /> SITE ADDRESS: '14S 7 ii. u- o t o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach_copy of Ibng legal description) <br /> OWNER Phone/E-mail • _ <br /> Address City/State/Zip <br /> APPLICANT: Owner Owner's Agent _Contractor op-"-Contractor's Agent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR/97072 ce'i14,..reo,,—,...+,.seta,/ 7, State Lie,# 4/43,ehi R giyx, City Bus. Lic.# <br /> Address riv <br /> .$ ( 4,,a/ r ��O <br /> vrr/s,/ .4'!a ?e- Phone/Email d g4-S¢a <br /> TENANT BU NESS NAME CONTACT FOR PERMIT • <br /> 76 .6";4-1 ,je.af.,„4_, <br /> Phone/E-mail /7': 4V /e9 4o+rel'irvz.-0,..y, I.;!,., <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (t()/-1 <br /> Existing Use of Building 67'a� S-6x'4`0') HEAT SOURCE: <br /> Proposed Use of Building f4,—,._ Gas_ Electric Other <br /> • <br /> Building type: Single Family 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):sp <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 I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer <br /> Range hood ' Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) • <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> BoilerI Drinking Fountain <br /> { Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> • <br /> Ducting I Roof drains <br /> Other — Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> fNumber 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 /> i <br /> - <br /> \'o�" —� (Revised 4/2015) <br /> Owner/Authorized Agent Signature Date <br />