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. PER' IIT PUUCAT O R <br /> ULD NG/MECHA ACALIPLU BINE/S GN1SPR N SLE.TqDEMOLITIO <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 AD 1 RESS: _ PROPERTY TAX# PFRNntT <br /> ■i. . , - Ever of Gtr 1 J ao3 2-0 ia(f3 7O a C� ��-D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of <br /> _Ibng legal description) <br /> OWNER A vle 1K- <br /> - u t aCek Phone/E-mail KV tare--A 01`1 O+W.&c ll.CoQ . ... <br /> Address 1 Z(j S y"?..)tj I bl S-1. or) f ' d'* City/State/Zip o f (,t j4 2.. ,,_ , , _: <br /> APPLICANT: Owner 1rOwner's Agent •_,Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTORS '%4 /I t' ! V QRI` T 1i077477`04/%� State Lic.# Se/- 1-04. 82 C F City Bus. Lic.# <br /> Address r2,,,f (30-r_< Sr;• _ce it A eA/�`-7(`�1 _k___ �/g�' <br /> Phone/Email 2) �7)/^6 4/y/ .SD�-th),HES �F/4jl, <br /> TENANT BUSINESS NAME I CONTACT FOR PERMIT S6` <br /> \ctlker-1Aiet_at - <br /> i" 15516 A Ave.ve. vv o� sw <br /> f ry - %SozG <br /> Mer-Velt et. N6-'Mc�=t Cov1n . Phone/E-mail.Vs 50. eve< 1 M t , c.0 F--•' • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1/ 59, '7Ll.e& b <br /> Existing Use of Building_V 6K , .viv- \11-17-)s-e HEAT SOURCE: <br /> Proposed Use a o • - Gas_ Electric( Other <br /> •e: . Single Famil Duplex Townhouse Multi-Family Commercial <br /> Building ty Y — <br /> Type of prole- _ lew _Addition —Remodel _Repair_ T.l.—Sign Sprinkler__Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> • <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 '3 . Toilet <br /> • Forced air systems 1 I Bathtub <br /> Gas piping Lavatory(wash basin). <br /> t Water heater. I I Sliower <br /> . 'J Gas fireplace ( . Kitchen sink&disposal . <br /> Gas range ( Dishwasher • <br /> I Clothes dryer 1 Clothes washer <br /> 1 j Range hood Water heater <br /> �f Exhaust fan I Sink(service/bar/mop/etc.) <br /> `f <br /> Heat pump Backflow preventer(inside bldg) <br /> Urin •al Unit heater . -• <br /> BoilerDrinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove j Grease trap <br /> Ducting Roof drains • • . <br /> . I Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM ? Other: <br /> fI 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 16.27 RCW and 296.200A WAG. <br /> ��- 1l/// V Rev'sed4/21795) <br /> 0wnerlAuthof•• Agent Signature Signature Date <br /> 12.-.. <br />