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illk) <br /> lk <br /> ERMIT APPLIATI <br /> • <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLIER/DEMOLITION <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: I, I PROPERTY TAX# PERMIT# ; <br /> 51 3 IA i`c)k veiy kac- 9'XZo 4903r:732-69a 0 J _.&/,61 fI ,-0 I..( <br /> r <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER P AVA-eiCA_A U 4 Phone/E-mail KU LGA A G{�0-64,0 ‘Com <br /> Address I zo5 13o`fh 51-, SE f 4- Cv - , 32O City/State/zip <br /> APPLICANT: Owner f,/-Owners Agent _Contractor Contractors Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR 6"- 4:71-es- li vrfL12,0/(104% 0rpr-pow at State Lic.# SEATI))4 082c t'City Bus. Lic.# <br /> Address 24,1 /30 R .f, Ce A4-. 67,,,x,2(5;7-(,- ci//- 4e 2..0, Phone/Email 41. -5 ,' 6##.1 i '5D4-I ala 66,4,4;1 <br /> TERACONTACT FOR PERMIT / J c; <br /> Ilit <br /> .4- S-5®1-6 444 .\ Phone/E-mall 5-AA-tf--0/7 is &NtY(L r Ca 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK— 7 , <br /> Existing Use of Building M/ HEAT SOURCE: <br /> Proposed Use of Buildin• PILl _ <br /> ,.-- y, Gas Electric // Other <br /> Building typ Single Family _Duplex Townhouse A i 1E4 10- ommercial <br /> Type of project: /New Addition _Remodel _Repair . ._ ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> N moi— A.=1 -i 4-i{ D <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 4&w_Adds _Alteration_Repair Type of Project: ZNew_Addn ^Alteration,_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 3 Toilet . <br /> Forced air systems ) Bathtub <br /> Gas piping 4 Lavatory(wash basin). <br /> Water heater 1 I Shower <br /> I Gas fireplace 1 Kitchen sink&disposal <br /> Gas range l Dishwasher ` <br /> j Clothes dryer I Clothes washer <br /> I Range hood Water heater <br /> J Exhaust fan 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 I 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 I am auth ri ed by the owner of this propertyto perform the work for which ap Iication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r,,(,6(, <br /> Owner/ uthorized Agent Signature <br /> g Date (Revised 4 <br />