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� • <br /> r��IY1�� /'1�r�'4�� 1 �`�1�1 <br /> �IJILDING/MECHANICi4L/PLUMBING/SIGN/SPRIIVKLER/DEMOLI°TION <br /> CITY OF EVERETT PERMIl'SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evere`ttwa.o g <br /> 1�� '�1 <br /> SITE ADDRESS: PROPERTY T X# PE MIT# <br /> ,�D'Z. �I�� � �0 �02��� �0 �� �Q� ���(` <br /> LEGAL for new construction: Short PlaUsubdivision �-�� �8� g Lot No. �(attach copy of long legal description) <br /> OWNER ��'�f'� ���il"° ��b ��6 '_' ��' ''m <br /> Phone/E-mail �� <br /> Address 6�?�� � ��O ��, �'s City/State/Zip Mq��a►a c.�� �t�- �j"2.� <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor�S A92flf _TBflBflt(must provide a letter of consent from the ownet lo do work in Ihe space) <br /> CONTRACTOR � �� /� (.tll.(�� Q{.1fi1L State Lic.# City Bus. Lic.# <br /> Address b��° � �� VJI--• k� ��S{1j l.{�� {� l�� Phone/Email �'7�� ���a — ��� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �.w�� �� <br /> �� <br /> �������- I � ��� Phone/E-mail ��0�� �� �o�' �,�2,�'" <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�� 9 DO_ � <br /> Existing Use of Building ��/�'�'�f'f �,�- � HEAT SOURCE: <br /> Proposed Use of Building � I ���'°y1 r�4 f��- �/ Gas (/� Electric other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of pro'e� ct: _New Addition Remodel Repair s�T.l Si n S rinkler Demolition Chan e of Use <br /> ���-- -- <br /> DESCRIPI'IOPI QF WQRlC(additional space provided on the back): <br /> �_Or�s �r�rz ' �'N�f�� ' f��. , �s�w t�� ' �T�► � ��. t�r <br /> o��.s�(�. °�� � �� �"v e ��.� � ���. o <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteretion_Repair Type of Project: _New_Addn _Aiteretion_Repair <br /> Show Number(#)of fxtures Show Number(#)of fxtures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Z Lavato wash basin <br /> Water heater � Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e j � Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan � Sink service/bar/mo /etc. <br /> � Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 Iaws and ordinances governing this type of work will be compl <br /> with whether specifed herein or not.The granting of a permil does not presume lo give authonty to violale or cancel the provision of any olher slate or local law regulating wnstruction <br /> That I am authonzed by the owner of this property to perform the work forwhich application is made and I comply with!he State Contractors Law 1827 RCW and 296200A WAC. <br /> -� ,�,,...-� p�,/�%�' `��� <br /> O er/ ut rized Agent Signature Date (Revised 9/2014) <br /> � O� ;� <br />