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PLJMF <br /> CITYKO-` =ERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.eiet�.org <br /> -rl'Uu <br /> SITE ADDRESS: PROPERTY TAX# `�1T� i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER Phone/E-mail LAZ5'"3Gis• 07 CXD <br /> Address -7 V �,, �; ,, City/State/Zipov IFIL4EfTT� W A GI is 2-61- <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 )s'j /�S State Lic.# City Bus. Lic.# �2�2 <br /> Address 7b7o NJE6c 06 , Phone/Email <br /> TENANT BUSINESS NAMF CONTACT FOR PERMIT <br /> Phone/E-mail `IZG 3cyc:.c-L; 2L, C, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building aT'L,,�t ��'d'`' t"'' HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: _New _Addition —Remodel _Repair T-1._Sign___Spdnkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _--_New_Addn _Alteration_Repai Type of Project: _New_Addn YAlteration_Repair <br /> Show Number(#)of fixtures Show Number(#)o fixtures <br /> A/C–air handling units ! Toilet <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 htSod Water heater <br /> a t fan Sink (service/bar/mop/etc.) <br /> Hea pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> I�viler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> 1 Ducting Roof drains <br /> Other Medical Gas <br /> SPRI LER / SUPPRESSION SYST Other:Dka& <br /> Number of Heads Other: <br /> 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 theownerof this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> ' wi4 jim. 2 '7 20 15 <br /> Owfier/ uthorized Agent Signature Date (Revised 4/2095) <br />