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PERMIT AP' �,ICAT' I <br /> • <br /> ; UILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOUTION <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# PERMIT# <br /> M � /iSU504, W (61n-n0( <br /> LEGAL for new construction: Short Plat/su'bdivision Lot No. (attach copy of king legal description) <br /> •• • <br /> OWNER g,, ,, t J4 Ib Phone/E-mail 925- We"WO . <br /> Address J LAY'? 4777/4/2) �/L'gg) a i City/State/Zip fdJ r/2e (A1,4_ 57.26 2 / <br /> APPLICANT: Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to Op work in the space) <br /> CONTRACTOR FZW- jfl/4 6 21.2. State L•ic.#FROg ,cit24:9fl CitycBBus. Lis.#(3�C.Z. <br /> tLA E ,it �,a 98z.270 <br /> ¢ Phone/Email 7 :...:5/ -7/6 <br /> Address '�� :; `p; JZ�.�, � ''I// �� 1002'! <br /> 1 . . : I ' . • I CONTACT FOR PF MIT <br /> Phone/E-mail 4 .tv C <br /> BUILDING PERMIT APPLICATION• <br /> • CONTRACT PRICE OF WORK /10 X r <br /> Existing Use of Building . z°S', • HEAT SOURCE: <br /> Proposed Use of Building I?5 Gas ' Electric Other_ <br /> Building type: .Single Family _Duplex Townhouse _Multi-Family Commercial <br /> Type of project: _New _Addition _Remodel 4Repair_T.I. Sign__Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additiona4e/ <br /> ceprovided on the back): , ,& IQ ��,yt� <br /> ® 11)( 31/0 r -' &5we R94A)mac.) /�� U/�.viz <br /> e.MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New___Addn AlterationRepair Type of Project: New_Addn ^._,Alteration__Repair <br /> Show Number(#)of fixturesShow Number(#)of fixtures <br /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin). <br /> Water heater I Shower <br /> - , Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher , <br /> Clothes dryer Clothes washer <br /> • Range hood Water heater <br /> - - Exhaust fan I Sink(service/bar/mop/etc.) <br /> ' / Heat pump Backflow preventer(inside bldg) ' <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain _ <br /> Woodstove I Grease trap <br /> Ducting Roof drains • • • • <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM • Other: • <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 -- uthorized b a owner o ' prope to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296200A WAC. <br /> /* /6--/d2 "-- ' <br /> !• er/Authoriz t Signature Date Revised <2015) <br /> . ‘. I ‘")., <br /> • o,r , is-ogf-co <br />