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01-VW& -` <br /> WIT' "2. . <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 /> 28D5/Qp0/03LD'D <br /> SITE ADDRESS' p PROPERTY TAX# PERM T# <br /> ®5 1 4 ' Di\ SE 4212.S`/917,/P?1hDU C •• -0 t <br /> t*..ii' DF Ser. t rt► - <br /> LEGAL for new construction: Short Plat/subdivision i, Lot No. (attach copy of long legal description) <br /> OWNER I bR-11•41..LM GOAT" LLG Phone/E-mail Le zhelVW[AAA la p.weiAcrjdylwft+er•GOM <br /> Address I74ZI to I.-EI/Varr L4I V SVag WO City/State/Zip grill Et.L t UJ4. 48012 <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 Sit: RS cub we State Lic.# City Bus. Lic.# <br /> Address Stu& a' x6002_ Phone/Email Sf2 ar Mb 0V°t. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S-A a r Dc h ow. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ 1 S-2-1 SIT) <br /> Existing Use of Pi."'-- W/A HEAT SOURCE: <br /> Proposed Use or building_ 4TrA C- 4'SEj Tv '� Gas %,.. ElectricOther <br /> Building type: so/Single Family Duplex ✓Townhouse ✓Multi-Family _•Commercial <br /> ,---Type of project: ✓New _Addition ,Remodel Repair_T.I. Sign Sprinkler_Demolition_Change of Use <br /> JESCRIPTION OF WORK(additional space provided on the back): <br /> NSW ICWK) .1143, ukttr . -2. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓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 3 Toilet <br /> Forced air systems Z Bathtub <br /> Z. Gas piping 3 Lavatory(wash basin) <br /> / Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer i Clothes washer <br /> / Range hood r <br /> gExhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <br /> Unit heater J 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 /> 1 Number of Heads Other: <br /> ..oereby 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 6.200A WAC. <br /> • te/ /2 <br /> Owner/Auth.j •ent Signature , Date ----I—Revised 3/2013) <br />