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PERMIT APPLICATON <br /> BUILDING/N` ECHA8\AICALIPLUMF31NG/SIGNISPRINKLER/DCSIMOLJ` ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 08201 425-257-8810 FAX 425-257-8857 wvvw.everettwa.org <br /> SITE ADDRE-Q-G• PROPERTYTAX# Tdescri A&5050 J (7�LEGAL for new construction: Short t/subdivision Lot No. (attach copy of Ibng letion) <br /> OWNER �(� r2{� � i vL�� Phone/E-mail 'ZD&- -755- 5r2-2- <br /> Address <br /> 755- 512-2- <br /> Address $l j /Lp'600 City/State/Zip CV 11V e'4 , IATA <br /> APPLICANT:—Owner _Owner's Age _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR State L'ic,# City Bus. Lic.# 00-7`155 <br /> Address 2k-2,0. P-�C I�l G K.1/ U.t'� ( 2-©I Phone/Email Za 2S2 1 tl <br /> ANT 813151NES379= CONTACT FOR PEI�I;!!JT <br /> /n1/ {z-S-X52"3t y <br /> -5vN A71; �ei 1)t tq Phone/E-mail �GSI;A4WA'L'(� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use Df Building 6C,�(-t✓ -No C 6"A b HEAT SOURCE: <br /> Proposed Use of Building �� - `� Gas_ Electric ( other <br /> Building type: _Single Family _Duplex_Townhouse _ Multi-Family K Commercial <br /> Type of project: _New _Addition _Remodel _Repair=T.1._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> R �sys7�N6 f3noGt-u�J X119— "12AAa- 60*a� rev CJ416E N <br /> l b�-r�r�o,J ark ©cam oaoR �or4 62oo,10) o It NOOOr UNIT <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: —New ____Alteration Alteration Repair Type of Project: _New_Addn _.Alteration ' <br /> Show Number(#)of fixtures Show Number(#)of 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 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 / SUPPRESS90M 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 a thorized by the owner of this properly 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 /> T <br /> S 25-(6 <br /> t.9wTmIrMuthod a Agent Signature Date (Revised 412015) <br />