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• PERMIT , PPL CATh I= <br /> WILDING/MECHANICAL/PLUMBI G/SIGN/SP _IN KLEP/DE LITI9,N <br /> . CITY OF EVERETT PERMIT SERVICES <br /> ®�/� -/ >ar <br /> A <br /> 3200 Cedarw <br /> St, Everett, WA 98201 425-257-8810 FAX 425-257-8857 ww.everettwa.org <br /> SITEADDRESS:l ft PROPERTY TAX#t pFPnnrr <br /> E <br /> . <br /> �� .� 7 073 Zo l�(nZ7O a 0 D Z6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> OWNER i'I Y 1„'1,+ KU tate Phone/E-mail KV fC- Gt_a.,g o+rA it'..CDw\ <br /> Addvs <br /> ress 17 o s ��j b k .S 4 (M P 'f A- City/State/Zip ESU S Iv A 9 Z <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 /> CONTRACTORS 4Y/CC' d�Wit?PP6n'' i T/4 /"1 (State Lie,# s ek rr.s4, '2 C. / City Bus. Lie.# <br /> i-r , Phone/Email kip/^6�/// .SD✓tfh M S H C, <br /> Address �Zc7.� (�� 1-;'. �,� �'A L-�/� / `�� "I��� I � � // <br /> TENANT-BUSINESS NAME • I 1 CONTACT FOR PERMIT Mctlne -Wei..O0 - <br /> P{Gther-Vefe-- G'vvat) .Covv\ ›.Phone/E-mail.'4tb co _ ,iyr'S' 1 -/-f' f. , C ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK IOW/ e7Ligot h/ <br /> toi <br /> Existing Use of Building V cG'ctvk Y\.ta.:Js-e• HEAT SOURCE: _ - <br /> Proposed Use a : . • - Gas_- Electric Other_ <br /> Building tyse: ,g,_Single Family, Duplex Townhouse _Multi-Family ,_Commercial <br /> Type of prole- `ow __Addition _Remodel _Repair_T.I._Sign Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> AlEtJ $F - Mfr-rn , / <br /> 'MECHANICAL PERMIT APPLICATION '. PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn AlterationRepair Type of Project: New_Addn Alteration_Repair <br /> - Show Number(#)of fixtures Show Number(#)of fixtures <br /> I <br /> NC-air handling units Toilet <br /> . Forced air systems I'' Bathtub - <br /> Gas piping 4. Lavatoryo (wash basin). <br /> I Water heater. 1 I Shower <br /> Gas fireplace ( Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> I Clothes dryer t, Clothes washer <br /> ' rE 1 Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> • Heat pump <br /> Backflow preventer(inside bldg) <br /> - <br /> Unit heater Urinal • - - . <br /> 1 Boiler I Drinking Fountain <br /> I Refrigeration Floor drain <br /> I Woodstove I Grease trap <br /> I Ducting I Roof drains <br /> - 1 Other - ! Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM • Other: <br /> tld--- .. <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 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 /> s/7 '/c , <br /> g nt ���2— Date (Revised 4/2015) <br /> Owner/Author'-- Agent Signature <br /> • Y <br />