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10/25/2016 TUE 11: 49 FAX Fast Water Hester ra043/005 <br /> DERMIT APPL1CATVIV L - 3(39-- <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 ADH.S5: F 5Y PROPER 1• # 'i,IT <br /> CP 6 -'0 0 <br /> LEGAL for new construction: Short Plat/subdivision _ t-ot No. (attach copy of long legal description) <br /> • <br /> OWNER r:7i-e_ � jaP Phone/E-mall L-05- Li) st '74'4g <br /> Addreee ' I Sr 5 City/State/Zip eV-C/rei a)" / gaog 0 <br /> APPLICANT:_Owner _Owner's Agent Contractor Contractor's Agent .Tenant(must provide a letter of careen(from lee owner to rte work In theepace/ <br /> CONTRACTOR ' Mg k A . ' ' 14' State Lie,# A WW1— g'City Bus. Lie. �� <br /> Address_ 1- I/ULS � <br /> � O• — alp - l f.%ta:r WG„ Phone/Email 103 , Wig - oft;475 o'JI7"!/� <br /> E ^ .' t USINE a NA E <br /> CONTACT FOR PERMIT rt r • r. yr <br /> 1 Y 4 4)) <br /> Phone/E-mell „CI , is., t.., rr/.ill."r A; <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ���i(I 1 6iei <br /> Existing Use of Building Sr"' _ <br /> C f e MEAT a E: <br /> Proposed Use of p <br /> Gas Other <br /> Building type: Single Famil Duplex Townhouse Multi-Family —Commercial <br /> T •e of•ro act: New Addition Remodel O<.Re.:l .1. Sin S•rinkler Demolition • Chan a of Use <br /> DESCRIPTION OF WORK(additional space provided o b W: <br /> MECHANICAL PERMIT APPLICATION ..0PLUMBING PERMIT APP • CATION <br /> Type of Project: New^AdenAlteration.Repair <br /> Type of Pt• act: New_Addn _Alter on_Rapptr <br /> Show Number(#)of fixtures <br /> NO—air handlln• unite Show Number it of F/xtu;:a _ <br /> cd Toilet <br /> � ;s reepipingairs stems Bathtub _ <br /> � r heap __ Lavoro; wash basin --- <br /> She :r <br /> Ilr <br /> WiEMMOMMGas r •e KI en sink& •is.osal <br /> 11 <br /> Clothes d = - - t%shwasher 11111111.1110 <br /> wri <br /> . Ran•e h T • L Iothes washer�xhauai; •--'--- Q er heater .ewi <br /> Heat . — ""' service/bar/mo./etc. <br /> r _ _ Backil. preventerQnsIde bldg) - <br /> a, - __ — <br /> 1.1.1111111M. Urinal • <br /> 111iirefrl.eratlon <br /> Drinkln; F rain <br /> • Woodstove Floor drain <br /> r Duotln, Grease'tra• ,, <br /> �r Other <br /> Roof drains <br /> LER / SUPPRESSI• SYSTEM Medical oas <br /> IiiiV <br /> Other: <br /> Number of Heade Other: <br /> I hereby oertlfythat I have reed and examined this application and know the same to be true and correct.All provisions of laws and ordln noes governing Rae <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate er cancel the provielon ore other state or local lawpre regulating oce of work belcomp <br /> Mal I a authch :by the owner of INS properly to perform the work Ibr Which eppiloallon le made end I com with8 A ructlon <br /> try <br /> PlY the Stets Conlrectprs law10.27 ROA/and 296.2ppA WAC. <br /> Dwner/A Ir"orized Agent Slgn r ure <br /> Data <br /> (Revised 4/2016) <br />