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PERMIT APPUCATUWq <br /> BUIL®ING/MECHANICA ,/PI UMBING/SIGN/SPRINKLERIDE 1;61OLITION <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: )-70(a \)I(11„1N(A f'V&- T <br /> PERTYTAX# P RMITkl_D-- e r <br /> lL <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> OWNER S 6,J/aQ..T MC .k)L U Phone/E-mail <br /> Address �&q g,4w .1-0 A,4 . eAqCity/state/zip r6 o pML WA`r W.4 Gi <br /> APPLICANT:—Owner K Owner's Agent _Contractor _Contractor's Agent _Ten ant(must provide a letter of consent from the owner to dp work in the space) <br /> CONTRACTOR Tv - State Lic,# �/CJIrJV VL 3 T City Bus. Lic.# <br /> Address 'L2'j (Sr1,�,1=V Ur y� �} ($] Phone/Email 7-06 Lj?g.- 1041 <br /> TENANT BUSINE55 NAM- CONTACT FOR PERMIT A4F X <br /> Phone/E-mail 20�i'y L" l<<(, a.LCX�G YENOEs:•Gf�M <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 16(� Q - <br /> Existing Use of Building 140USF, S FR HEAT SOURCE: <br /> Proposed Use of Building l-Hotter " 5FRI Gas_ Electric Other <br /> Building type: _)�_Single Family _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): 3�N� /�Q ND�A(L TD �V; r.; <br /> NG► � <br /> 1NF'LV 1IJ-ff.4�� �/ <br /> S � G Wp�W v�/_6PWi1S��, ,t.t�s3, �► Y <br /> GRI Q COA oto�N (JJ<S A �� �F�(.� vc� 1t�f,� o �Odv� c•�/ c e, <br /> LA <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _,New_Addn ,_,Alteration r Repair <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 Roof drains <br /> Ducting <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 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 the owner of this property 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 /> Owner/Author• gent Signature <br /> Date 1 (Revised 4/2015) <br /> v <br />