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PERNT APPLICATION <br /> BUILDINGIMECHANICAL/P[UMBING/SIGNISPRINK ER/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 ADDRFG; PROPERTY TAX# PERMIT# <br /> �Q�L1-8+� E 1- 3E �L <br /> LEGAL for new construction: Short Plat/subdivislAwlyr ts Lot No f (attach copy of long legal description) <br /> OWNERS ._ ( kZj"(;1( - Phcne/E-mall <br /> Address V2.0W —�o �/. 1��,�1� i�f(� City/State/Zip r.,09it, f-t G1 <br /> APPLICANT:—Owner _•Ow/�ner'sAgent (Contractor _,Contractor's Agent _,Tenant(must prosdeeletter ofconsentfrom rhoa&rkrtodovorkinthe space) <br /> YJ <br /> CONTRACTOR MLaCi!/l J rib rtr �') J►`IGj IState Lie.#MN AIIA)-X,��7�� City Bus.Lie.# <br /> Address N GIS l) fU .SL(!r1`f FD o hor n i PhonetEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 4 <br /> Phone[E-mall `1V-5 ?)HR <br /> BUILDING PERMIT APPLICATIOM CONTRACT PRICE of WORK <br /> Existing Use of Bullding HEAT SOURCE: <br /> Preposed Use of i3uilding Gas,_ Electric Other <br /> Building type: ___,Single Family _Duplex—Townhouse_Multl-Family Commercial <br /> TYPO Df ro act: New Addition Remodel —Repair T.I. Sin Sprinkler_. Dernolition Chane of Use <br /> i <br /> DESCRIPTION OF WORK(additional spaceprovided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New—Adds _Alteration,___,Repair Type of Project: _New___Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> AIC-air hand[Ing units Toilet <br /> Forced airs stems 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 servicelbar/mo !etc. <br /> Heat pump Backflow pfeventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Dueling Roof drains <br /> Other _ Medical Gas <br /> SPRiNKLER/ SUPPRESSION SYSTEM Other: <br /> - 9-2- Number of Heads Other: <br /> 1 hereby certify that I have read and examined this appl`caton and know the same to bo true and correct.All provisions of laws and ordinances governing this type of vrorkw1lbe compt <br /> with whether spaaeed herein or not.The granting of a permit does not presume to give authority to violato or cancel the provlsbn of any other state or local law regulating consWctbn <br /> Th m authorize by the as of this�prop ����is made and I oomptywith the Stale Contractors Law 18.27 RCW and 298.200A WAC. <br /> owner/ ut orIzeU Agent 81kpfure Date (Revised 9/2014) <br /> 13 <br />