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PERI\:&IT kPPL1CAT <br /> zULDING/MECHA ACALi LUMBING/SIGN/SPR NKLER/DEME LIMN <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 ADDRESS: PROPERTY.TAX# pFRnnrr <br /> ISE J <br /> 51-f/ h ki 0_ Ev i-_-,7 01 i OOH%720 cJ/o 2.70 0 (>15_1_Q0714 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy <br /> dofflongi legal description) <br /> • A <br /> OWNER VeveI' Ku ta�Gf Phone/E-mail kV la -- Yl <br /> C�t al' e it,CO <br /> . ... <br /> Address 120 S t t�l S 4 Se (}0p 1 4 City/State/Zip e' 7- J .. L,t )'1 / ?Z Ds <br /> APPLICANT: Owner //Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to rip work In the space) <br /> CONTRACTOR Se-ef Tt 6 6670-7.4/*P•47/10774770,11 SCC tate LIG.# s ekIT-O4 S S2 C- City Bus. Lic.f# <br /> Phone/Email 5�/^rl�iC1/ SU1tH���S �N�7C' <br /> Address 30 7f S=; �� Ft L'-1/ (1` ',fC NTC I ` <br /> F .t ----- CONTACT FQR PERMIT �/\Ctl/� t—Wems[a,o - <br /> �" 15SIG 5 AVE. w v%&0,,4tl; wy ggoz6 <br /> Maher-Vera,- G`Ma-t I „Cow. Phone/E-mail lit 56 ry6-s ) -M, e- , c.0 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1591 '74eat. hbil <br /> Existing Use of Building_\I aC v\k" -kgJ3-2 HEAT SOURCE: . <br /> Proposed Use o : ' G• - - Gas_ Electric Other <br /> Building ty•e: ,Single Family;—Duplex_Townhouse _Multi-Family ^ Commercial <br /> Type of prole- _ 'ew Addition —Remodel —Repair_T.l.—Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> /alai) 517q - i & fib <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 c-• 1 LaYafory(wash basin). <br /> I Water heater. ; ( Shower <br /> Gas fireplace t Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> 1 Clothes dryer t Clothes washer <br /> i I Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump <br /> Backflow)5reventer(inside bldg) <br /> Unit heaterUrinal _ <br /> Boiler _) Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: .. <br /> I hereby certifythat I have read and examined this application and know the same to be true and correct All provisions of laws and ordinance s 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 /> Z� g/7/zC9fs , <br /> `�• Date (Revised 4/201.5) <br /> owner/Author•- 'Agent Signature <br /> ,r- <br /> °� <br />