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REMIT APAP L aC A 11 <br /> BUIL®ING/MECHANICAL/PLUM13INGISIGNISPRINKLERIDEMOLITION <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# P MIT# <br /> p 1 01 <br /> >,v� X82 v <br /> �rvoct/ - . t✓enc <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER. v'>�,�¢" <br /> PhonelE-mail j'Z' c�f -s` '/.� o-�� �,"V e`' <br /> Address City/State/Zip <br /> APPLICANT: Owner _OwnerAgent _Contractor _Contractor's Agent _Tenant(must provide a letterer consem from the owner to ap work In the space) <br /> CONTRACTOR Y a, ��<<• State Lic,# City Bus, L.ic.# <br /> Address Phone/Email <br /> TENANT BUSINESS 19AME CONTACT FQR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building T.e-A a !'� - oa�� �'o }`'" °`` HEAT SOURCE: <br /> Gas_ Electric Other <br /> Proposed Use of Building �0 CLZ <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 novided on the bac nn \\ <br /> � <br /> _4 �.fw� t'oo� z�t >„5; L)VA <br /> �'v\ l- a � In �\ 0-, I( Ctln� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> _.New_Addn __-_Alteration_Repair <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: <br /> Show Number(#)of fixtures Show Number(#)of Fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas Lavatory(wash basin). <br /> piping <br /> Shower <br /> Water heater <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 /> Backflow preventer(inside bldg) <br /> Heat pump <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting Roof drains <br /> Other 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 specified herein or n .The granting of a permit does not presume to give authority to violate or cancel the provision of any other slate or local law regulating construction <br /> That I am authorize the own r f this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.7.OeA WAC. <br /> / Date (Revised 4/2015) <br /> ow <br /> ized Age" ignature <br />