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����F�6�� �°'A�������' <br /> �UILDING/MECHANtCAL/PLUNIB1IVCa1SIG(V/SPRINKLEF�/DE�IIIOLIT'IOIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evereft, WA 98201 425-257-8810 FAX 425-257-8857 www.everetiwa.org <br /> SfTE ADDRESS: ,,q_ PROPERTY TAX i# PERMIT# <br /> t�• �G �c.���-�� l.�'' l C'7��� �j � ; C.:r�c'��.; .��/CX% - �i� � <br /> LEGAL for new construction: Short PlaVsubdivision��'V'��F i tsti �,(�Q,S� Lot lVo.� (attach copy of long legal description) <br /> OWPIER �ch. pc�,�L � �(►'►-2 `j PhonelE-mail�aj-�(.S„�`o�`�l,''C,� lidfU/.`j�t cL�.�IGY�'It 5,.Lc"J <br /> Address�ap 5!� F�erc�'t �"(lei�, Wsa ��.0��"�. �� CitylState/Zip ��f�V t� �J�: , G( � �� <br /> APPLICANT:��Owner _O�vners Agent _Contractor _Contractor'S Agent _TOnent(must provide a�etter ol consent from the owner to do�vortc in the space) <br /> C�NTRACTOR,j�� Qo[c: o M+eS State Lia# "' I�T�� 005�3u City Bus. Lic.#(p03- �0�3 0 <br /> Address �OSW �IiCr�!{ I`�'14�� Wc �s•�e �u� �vGc� wA ����v�f ` Phone/E��`!����� Zvr�.S�•: •.c�c,-,�'.cv: <br /> TENANT BUSINESS NAME COIVTACT FOR PERMIT <br /> m�.-� ��7r���b����. <br /> Phone/E-mail �„�j�3f S-. `/3C?/(Y�-[-f,t��c,��Z�� ��/�eS.C�M'1 <br /> Bl1lLDING PE�tMIT d�PPL.IC�ITION CONTRACT PRICE OF WORK I �' -��} <br /> Existing Use of Building HEAT SOURCE: <br /> Pfoposed Use of Building Gas Electric_ Other <br /> Buiiding type: �5ingle Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: �New Addition Remodel Repair_T.I._Sign_Sprinkler_Demolitian Change of Use <br /> DESCRIPTI�P! OF!IVORK(additiona!space provided on the bacic): <br /> ' � ��3 C ��3 - �.�:,-� c�� <br /> iV1ECHANICAL PERMI'1' APPLICA'TION PLUMBIt�It� 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 handfing units ; Toilet <br /> � Forced air sysiems � ; Bathtub <br /> ?, ; Gas piping � Lavafory (wash basin) <br /> ( ; Water heater / ! Shower <br /> 1 ; Gas fireplace 1 ; Kitchen sink&disposal <br /> J i Gas range / ; Dishwasher <br /> � � Clothes dryer [ j Clothes washer <br /> � � Range hood � a he <br /> � Exhaust fan i Sink(service/bar/mop/etc.) <br /> � Heat pump � Backflow preventer <br /> ; Unit heater I Urinal <br /> ! Boiler i Drinking Fountain <br /> Refrigeration i Floor drain <br /> � Woodstove � Grease trap <br /> i Ducting ! Roof drains <br /> � Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> INumber 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 Iav�s and ordinances governing this type oF work will be coinplied <br /> with whether specified herein or noL The granting o�a permit does not presume to give au�hority lo violate or cancei lhe provision of any other stale or iocal faw regulatfng construction <br /> That I am authorized by the o+�rner of this property to pertorm lhe work(or�vhich application is made and f comply with the State Conira�tors Law 18.27 RCW and 296.200A WAC. <br /> � � j z: <br /> _;�;'���!` ���--�-'°�- �% - �3 __� y � __ <br /> QwnerlAuthorized Agent Signature Date (Revised 3/20i3) <br />