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t-oiN6 pt <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 /> 2805/ig190/O3Z.Pt <br /> SITE ADDRESS: �1 PROPERTY TAX# PERMIT# <br /> � ,y <br /> LEGAL for new construction: Short PlaPt/subdlvlslonvP c-,r t. ,, Lot No. (attach copy of long legal description) <br /> OWNER IORM.AM GOAT 1-1-G Phone/E-mail L_Ezhelw e- ta.l ACride61614er.tAAn <br /> Address 17°Zt &D ,L-E 11.o`,tr (41,()y S t tT(i Mil City/State/Zip gort4 51A.. r wf4.. ROO(Z <br /> APPLICANT: Owner ✓Owner's Agent _Contractor _Contractors Agent Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR SQ'"'G aS 04t7M State Lic.# City Bus. Lic.# <br /> Address SaMt►Q. CIS ab01JQ Phone/Email Scuff ar Rbote <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail $'aw-ar above. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1 8 tit $t32 <br /> Existing Use of R,4"...- 11/A d tHEAT SOURCE: <br /> Proposed Use or building_` A 4•SOGas Ne.'.. ElectricOther <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> ,—Type of project: ✓New _Addition _Remodel _Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> .ESCRIPTION OF WORK(additional space provided on the back): <br /> 1451.0 'tcWJ 'DONE Vkylr r-b, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _•_Alteration_Repair Type of Project: ✓NewAddn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units '3 Toilet <br /> / Forced air systems 2 I Bathtub <br /> 2.. Gas piping 3 I Lavatory(wash basin) . <br /> / Water heater ( Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer �--i----C4414481s washer 64-- <br /> Range hood <br /> fn Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump / I Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> .„ereby 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, WAC. <br /> ,Z 1, ei, ?cry 1/2\J <br /> Owner/Author” Cent Signature Date (Revised 3/2013) <br />