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Jan. 27. 2016 12 ; 21 PM No. 1757 P. 4 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 PAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROP):li'lY TAX tt T# O U <br /> LEGAL for new construction: Siwrt PlausuhdlvlsIon, .... Lot No._.......... (attach copy of long legal description) <br /> OWNER `' e �. t,._ ,. <br /> ;��d`�y�`�£�.;;:�..��� Phone/L-mail :� "t�`s ��°e.., ._...17 .,'c <br /> Address h zi•� Cal iSlete/Zl <br /> " c' �✓ .7 <br /> APPLICANT: Owner —Owner'sAgunl Contractor Contrartor'sAgent _Tonant(nuistprnvldaahp'trMconsantfromthe av tudav kinlhebpficej <br /> CONTRACTORS Stale Lic.# Chi' w :g x., City Bus.Lic. <br /> Address .ham 1<,. h PhonoiEtnali �'i Z,�. j <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> BUILbING PERMIT APPLICATION CONTRACT PRICE OF WORK ''' -- i' <br /> Existing Use of BuildingHEAT SOURCE: <br /> Proposed Use of Building Gas Eloclrle m Other—. <br /> Building type: —X single Famlly Duplex_Townhouse _Ml11tl-Fatuity, _Commercial <br /> T e of ro'ect: New Addition Remodel Repair T.E. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additioner space provided on the back): <br /> LS(A <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _New_Addr) X'_Alloratlan_Repair Typo of Project: _New Addn _Alleratlorr• _-FRepaly <br /> Show Number # of fixtuf os Show Number # of frxlures <br /> A/C--air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas Pipinq Lavatory wash basin) <br /> Water floater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Wator heater <br /> Exhaust fan Sink(service/bar/rno /etc. <br /> Hcat Pump Backflow proventer <br /> Unit heater Urinal <br /> Boiler D(IiikIng Fountain <br /> Refrlyeration Floor draln <br /> Woodstove Grease tra <br /> Ducfin Roof drains <br /> Other .. Medical Gas <br /> SPRINKEER / SUPPRESSION SYSTEM Other. <br /> Number of Heads Other: <br /> I hereby umliry heal I leave read and examined thls applir Woo sed know the same to bo true and corn^rt.Ali piavisione of laws and ordinnnccs governing lhi::type al work vAll be comps <br /> willt wimll,er speciried heraln or not.Tho gnlntlno,d a pennll does not presume to vivo authalily to vinlAe or cancel the prWslon of any ollmr!;td-ii lucst law regulating consiniction <br /> Thal I sm authorized by tho own,-,r nr this property to penoml the work for whi,:h applii:alion is made and I complywith the St:,tc Cor,lrsolors Law 18.27 uC W and 20G.MA WAC, <br /> Owner)Atiftrized Agent Signature t Data (Revised 9/2014) <br />