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BUIL®ING/MECHA��9VCAL1PLUMBING/SIGN/SPRINKLER/DEMOLpTION <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 /> .1301 /VA. s - � - v � �"� F � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. t' (attach copy of Ibng legal description) <br /> OWNER L©&A/ Phone/E-mail 1rZ�j- Zr3j•-D <br /> Address l(J � ��jt�(� BtUD City/State/Zlp r�/-7,kir_ W A <br /> APPLICANT:—Owner _Owner's Agent -KContractor —contractors Agent _Tenant(must provide a leder of consent from the owner to dp work In the space) <br /> CONTRACTOR Ek r 60-Cl;-� � �fk j i�+�L(7 - Stafe Lic.# � `C?Z�E�l City Bus. Lic.# &p 1 6 5 <br /> Address 2.t-2,0 ,0(-tk(- AU c. A q 92.01 Phone/Email 42-13 i l � <br /> CONTACT FOR PERMIT <br /> �JA Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �2; r`�0 <br /> Existing Use of Building C---,tam,—e-v HEAT SOURCE: <br /> Proposed Use of Building...... Gas_ Electr)q_)Z Other <br /> Building type: Single Family -k 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): <br /> �Epf� ��5� ���asao s-C�,a r a�25 ����c E•Fawrr.�t�,,�,'I <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 J Toilet <br /> Forced air systems Bathtub <br /> Gas piping I-aVatory(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 /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting J 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 compiled <br /> Will wh 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 m aui odzed by the owner of 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 /> t3pGfittr/Authori7-1;�l 5i nature Date (Revised 4/2015) <br />