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1 VI\1��� � /"l� � L..�Vl7 � �v� � <br /> BUILDING/MEC� � � NICAL/PLUMBINGISIGN/::��INKLER/DEMOLITION <br /> � CITY OF EVERETT PERMIT SEFi:ii;ES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: .-, ., PROPERTY TAX# P T <br /> �� � .� '� I r-='4__ 00 f � DOf�d UOl� <br /> LEGAL for new construction: Short PlaVsubdivision Lot No: (attach copy of long legal description) <br /> OWNER�UG���/i �"U�f���i f��TfTd�Z Phone/E-mail y,( .�Z�O , ��� <br /> Address�D,�DX ��?� Ciry/Stat�p��/PG����I �G�� <br /> APPLICANT t,�Owner _Owner's Agent _Contractor _Contractors Agent _Tenant�m�s�P�o�iae a ianar oi consem rrom u,e ow�,er co do�o�c�n sna sPaca� <br /> CONTRACTOR ND�a/q State Lic.# ��s�'�- ���(?�Z, Ci Bus. Lic.#��Z- �,,'�� <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �ND�Y �{F'LT"/�E— <br /> CJ�7�d/ v��� Phone/E-mail �_�G. �,7 f��� ��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��ODO, 4� <br /> Existing Use of Building J`ri�i� HEAT SOUf2CE: <br /> Proposed Use of Buiiding ��/`�. ' Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Si � S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> t ��/ �l.(.� °��,t..�i�'t�..�--� <br /> � <br /> MECHANICAL PERMIT APPLICATION � PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Addn _Alteration_Repalr Type of Project: _New_Addn _Alteration_Repafr <br /> Show Number # of flxtures Show IJumber # of ftxtures <br /> A/C—air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i fn Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink E�dis osai <br /> Gas ran e Dishwasher <br /> Clothes d er Ciothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/badmo /etc. <br /> Heat um Backflow reventer inside bld <br /> Unit heater Urinal <br /> Boiler � Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other. <br /> Number of Heads Other: � <br /> I hereby certtfy that 1 have read and axamined lhis applicatlon and know the same to be true and correct.All provislons oi laws and ord{nances goveming thls type of work will be cor <br /> with whether specified hereij�or not,The granting of a permit does not presume to give authortty to violate or cancei the provislon of any other state or local law regulatlng constructl <br /> That I am authorized by,th owner of s property to perform Me work fo whkN ppl{catlon Is made and i comply with the State Contrectors Law 18.27 RCW and 298.200A WAC. <br /> '_ ( �-- <br /> \_ t� (�, ��i S <br /> Owner/Authoriz d Agent ignature Date (Revised 4/2015) <br />