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BVll,NI\J G `C„-,t . <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 /> 28D5IQO0I93z.010 <br /> SITE ADDRESS: ,_ PROPERTY TAX# P T <br /> lik <br /> ��,,, - wf <br /> LEGAL for new construction: Short Plat/subdivision l2.1g, Ni .-I a w. _ Lot No. (attach copy of long legal description) <br /> OWNER 4RNl.AM GOAT LLC. Phone/E-mail Le he.)Ink r.A I►_ ?mak rj idle kome.r.I;aM <br /> Address 17rtzi to-mat-Et/ear btivii St7►Tg IIT7 City/State/Zip Rf7r 4 ELI. t I(/i4• a81 (2- <br /> APPLICANT:_Owner ✓Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 5•04^^4- c4 vi-b(me State Lie.# City Bus. Lic.# <br /> Address $WA& CIS R.bUt1i Phone/Email SIS ar CO)Dve. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail scum?.LU xi)ovp <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK * 2I t ►9S2-. <br /> Existing Use of Riiitat~- t4/A HEAT SOURCE: <br /> Proposed Use ur building_ AlrA�FJ �J „ Gas v..' Electric Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family Commercial <br /> •--Type of project: N./New _Addition _Remodel Repair T.I._Sign Sprinkler Demolition Change of Use 1 <br /> iESCRIPTION OF WORK(additional space provided on The back): <br /> 14510 N 1101a6 TIT' 14.-1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓Blew Addn Alteration -Repair Type of Project: ✓New_Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units J Toilet <br /> ' Forced air systems ______7— I Bathtub <br /> / Gas piping S' I Lavatory(wash basin) . <br /> z Water heater / I Shower <br /> / Gas fireplace / I Kitchen sink&disposal <br /> Gas range / Dishwasher _ <br /> Clothes dryer / ; Clothes washer <br /> 132 -1 Range hood _ W <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration ( Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> • <br /> Other ( Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> .,iereby 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.- 'T7- • 95.200A WAC. <br /> Owner/Autt • Agent Signature Date (Revised 3/2013) <br />