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WERMIT APPLICATID1111 <br /> UILDING/MECHANICAL/PLUn IBING/SIGN/SPRINKLER/®EMOLITION <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# P^E,RMIT <br /> 2-717(7 r rl (, r4 AV e _ • f 7o W 3ci 6 €1€1,02/6q) U1/1 ( 0 g'�SS 7- <br /> LEGAL for'new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> OWNER P,,L, pf„u i ,_04, �C•�'r- A 5 14 a Phone/E-mail 4/25—3b y ”1 Dt>0 . .. <br /> Address 2, 0 • (.DNA I 3 2 6 1 City/State/Zip 5v erg L.\AA\ q tN2t )L1 <br /> APPLICANT: Owner —Owner's Agent A,Contractor _Contractor's Agent —Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR M 4.„-R-a- M L) ,;, ,j, State Lie,#VI E(L�TNCi_Lia,v,'M City Bus. Lic.#O/ 72-943 <br /> Address C.11 <br /> ,r t 15 Phone/Email ��� �,, �, rte..;, l.t. <br /> TENANT 51 SS r4 NF's �yONTACT F R PERMIT '� <br /> tA i Sk,1 )'l>r'c-c9-G--- <br /> 1--Ar,..-tc-.--" Or P i,L w P' C.c_.o._ Phone/E-mail• <br /> • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK i 110, liob <br /> Existing Use of Building HEAT SOURCE: <br /> • <br /> Proposed Use of BuildingGas_ Electric_ Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family N Commercial ' <br /> Type of project: New _Addition _Remodel _Repair X T.I. Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): j 5-1-6,tii-C r•9 H 4<,-4' v( S <br /> • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION • <br /> Type of Project:)4 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 Lavatory(wash basin). <br /> I Water heater I Shower <br /> ' . I Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher _ <br /> Clothes dryer Clothes washer <br /> I 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 /> I Boiler Drinking Fountain <br /> I Refrigeration Floor drain . <br /> Woodstove I Grease trap <br /> ! Ducting IRoof drains <br /> Other K i}c hr_., H r, s 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 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 WAG. <br /> ` — �. c —?...t2)—(S— , <br /> n p�re Date (Revised 4/2015 <br /> wnerlAuth rized Agent gndtu <br />