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PERMIT APPUCA` I(Al <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <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: PROPERTYTAX# T PERRU <br /> LEGAL for new construction: Short Plat subdivision `F Lot No. � l�p(attach copy of long legal description) +_ <br /> OWNER <br /> r\Vj\ /���� Phone/E-mail �� �U Z&col 1QL� % &ko3 C*l <br /> . <br /> tddres P(*o/` �Q�� City/State/zip 6}"-VN2Z M J '117 0' <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to Op work In the space) <br /> NTRACTOR p. �j �1�{rjT(��1��Q State Linc..1#3°'yCityC]Bus. Lic.# <br /> l 1 lG J� v�JV�= �vJ�1V�r1V �Sl W Q.I$ I V Phone/Email `tom,23�•Z� 12 <br /> Address <br /> tlWl'ti� CONTACT FOR PERMIT <br /> A4"''IJI�.,,,�AM5--S �(oLLA f, <br /> Phone/E-mail 4z5.�9 �- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building t S F(L HEAT SOURCE: <br /> Proposed Use of Building St C �l I� S Gas_ Electric_ Other <br /> Building type: ,�Single Family _Duplex_Townhouse _Multi-Family ,_Commercial <br /> Type of project: _New X Addition �Remodel _Repair_T.1._Sign Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space rovided on the back): �� <br /> �iutc,�as�v�� t o Ad o� ba+k ) (� s i -� 1�r��►ac��ww�g ��A1 <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 / 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 Por ba4h 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 /> Ducting Roof drains <br /> Other_ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: .�YQA( P) 1©-Co <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 a honzed by he 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 /> rA,f ,� a�- 5 C�O��►' G�.S �- Ib 62 2 ► — <br /> Own /Auth ized A e <br /> N.- <br /> Signature Date �nT bro6 /' (Revised 4/2015) <br /> V\,fPVW17AX12, <br />