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PERMT APPUCATION <br /> BML®INGIMECHANICAL/PL 1MBING/SIGN/SPRINKLER/®EIAA®LITION <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 AD RFcc• PROPERTY TAX# PERMIT# <br /> � _ S� � � __ -- <br /> LEGAL for new construction: Short Piatysubdivision N t IL I1 Lo!Nor. �+(attach copy of long legal descriptlon) <br /> OWNERS _ Q �Q `�1� � - PhonelE-mall Z/�tpj ej)n) ?'Voo — , <br /> Address ` - j SW �ly���ll' {}�1��V���//� l� Vf/ City/State/Zip F�tfQf 2i quo, <br /> APPLICANT:_Ovmer Ovm ,/, <br /> ersAgent Contractor _,Contractor's Agent _Tenant(rrust provIde a letter ofoonsent from the ow�ar to do vorkin the space) <br /> CONTRACTOR j /J7611� ��rf)F�G) State Llc.# ���;+V���.�17�5 Cil Bus.LIC.# <br /> n rrLL �` <br /> Address Y)f Gly tTVt 5Lt Jl< v2aNn S� t _1/� Phone/Email f.ZS' 3i4 J (7 00 <br /> TENANT BUSINES6 NAME CONTACT FOR PERMIT Ec <br /> PhonelE-mail �L'_JI MoD <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: _Single Family _Duplex_Townhouse — Multi-Family _Commercial <br /> Type of project.: New Addition Remodel Re air T.l. 5i n S rin ler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MEC"ANICAL 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 airs stems Bathtub <br /> Gas piping Lavato 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 preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Ffoor drain <br /> Woodstove Grease tra <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I 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.Aft provisions of laws and ordinances goveming this type of vrork w1 be comp! <br /> vrith whether specified herein or not.The granting of a permit does not presume to givo aulhority to violate or cancel the provision of any otherstate or local lawregulating construction <br /> 1h f'1 m authorize by the ow r ZtMsperty to perform the work forvrhlch appucauon Is made and I comply vdth the State Contractors Law 18.21 RCW and 296200A WAC. <br /> 11 t In � .. <br /> A <br /> ert ulhorize Agent Sihaafore Date (Revised 8r20f4) <br />