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PERNT i\ PPUCA4t <br /> B U LOI NGMECHANICAUPLUMBING/S 10 NIS PRINKLERMEMOLIT1®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereftwa.org <br /> SITE.ADDRESS: PROPER TAX# P RMIT# <br /> o �cr k, 0n� Zvo I�S'11 <br /> LEGAL,for new constru on: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �Q�j(�'(j i Phone/E-mail - 3 Z 7-3YZ <br /> Address ©� (._(/Q�2 rj pjy C(/ City/State/Zip C--6/ Q <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 ���� � ��Ac �j t� �i;[lV— State L-ic,# F-VE-I&550Z20T City sus. Lic.# 00-7415 <br /> Address 'Z1-2,0 �C(RC- Au e' . i V ( ./A q 9 Z0( Phone/Email 42-S- 2-G2 3 11 <br /> CONTACT FPR PERMIT <br /> �vl`r6 �L�Jn�i /✓ Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building A16 994!Y <br /> HEAT SOURCE: <br /> Proposed Use of Building !yV GasX Electric Other_ <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 spage prow d on the back): <br /> 12 /2 GAS " Al C1,0 sv� <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(#)offixtures Show Number(#)of fixtures <br /> A/C—air handling units l'oilet <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 /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> J Boiler ( Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting J Roof drains ' <br /> Other Medical Gas <br /> F:SPRINKLER I SUPPRIE'SSIOM 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 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 /> r-'X'NO-077.'� s <br /> Qggvj�Mthoriz fy <br /> ent5ignature Date (Re vlsed4/2015) <br />