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• PERI IT APPLIT <br /> BU1L®1N`-/MECHN\ACAL/PLUMB1 G/SIO1 /Sl l lN r LE /DEM•1 1TIIQ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St, Everett, WA 9.8201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> S �� PROPERTYTA?t# pFRnnrT <br /> SITE ADDRESS: ^ • <br /> ,.-X f`;.N/�3kWell <br /> #l_; -e Oo -40 ofo2.70a 04510 <br /> -074 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy off_long legal description) <br /> OWNER M Y IIt�'1�+ Ku (ace Phone/E-mail KV f aCei—C^0 Yl O3YYvo t) Co% v+r\ . ... <br /> Address 1 o S ��O '"` S 4 _SE £M.i'.I ,4 City/State/Zip C -r4 W 1 �-(? vg .._ .. <br /> APPLICANT:_Owner Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR 5g4 /I 6 6C— "QPI fa7749f"/ State Lie.# Sek'77 4 S S2 c.. f City Bus, Lie.# <br /> 7 (Phone/Emailfr/sem/�-64////-594,91014-c . .t>47l <br /> Address /2,9s- /j® - �-;• �� �'�4 f—Y�`'7� / 't'(%� J��' <br /> TENANT BUSINESS NAM — ( _ _ CONTACT FOR PERMIT Mallen`Wel..04a <br /> +-I ;• A <br /> 155/6 5641+ flute. w A-m.0, l; v/}4- ggoZG - <br /> 1"(ether-111efe 6-'M -•'t „e_01,tn , Phone/Email.Vs SU - r i16s 1 .-H, t . c4)Q-� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1591 e7tlex- W <br /> Existing Use of Building V ae .v,l - \ x, j_ HEAT SOURCE: - - <br /> Proposed Use o o - - Gas Electric Other <br /> Building type: ,g_Single Family _Duplex Townhouse _Multi-Family Commercial <br /> Type of proje . 'ew Addition _Remodel _Repair_T.I._Sign Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Nov sire - 4-7-7-- -b <br /> MECHANICAL 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 /> NC—air handling units Toilet • <br /> • Forced air systems I Bathtub • <br /> Gas piping G-. Lavatory(wash basin). <br /> I I Water heater. i I Shower <br /> Gas fireplace ( Kitchen sink 8&disposal <br /> i Gas range . ( Dishwasher <br /> I + Clothes dryer t Clothes washer <br /> 4 1 Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) . <br /> • Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal - <br /> 1 BoilerDrinking Fountain <br /> Refrigeration Floor drain . <br /> I Woodstove Grease trap <br /> 1 Ducting Roof drains . <br /> . I Other Medical Gas . <br /> SPRINKLER /SUPPRESSION SYSTEM • <br /> Other: <br /> Number of Heads Other: <br /> I herepy certify that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> a wner/Author'--■ Agent Signature Date (Rev/sed 4/2015) <br /> • <br /> • ( l/ - <br />