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Ult-D i N G SIG-' <br /> vor K•3 <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 /> -2:005'/QD0/03e,ov <br /> SITE ADDRESS.: PROPERTY TAX# PERMIT <br /> 1 U5 9. PyI r" ©�r 4ror`/9v0/P..iY-017 cit-10q--03 <br /> LEGAL for new construction: Short PlaUsu6dlvmis on 2irg_1 e w Lot No. (attach copy of long legal description) <br /> OWNER Ik X)4LLM Got/ LLG Phone/E-mail Le r he!VIN CVA a patictcri ay Iwwit,r.GOM <br /> Address l?gZI tQ %.11L Et/EQ;bIT 1401. Sf11TG 1127 City/State/Zip o 14 %A t khan. (00(7-- <br /> APPLICANT: <br /> 00IZ.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 SQ4"t RS 0.100tte• State Lic.# City Bus. Lic.# <br /> Address sat,* aS R.b011Q. Phone/Email SrdM+t IAS' above. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAMA a r a-hove. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKS 1 S Zl S-91, <br /> Existing Use of R,,'t,-- N/A HEAT SOURCE: <br /> , <br /> Proposed Use ur building' <br /> suudingA / -TvwNx-icitAt Gas ✓ Electric Other <br /> Building type: ✓Single Family —Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> ,-hype of project: N./New _Addition _Remodel _Repair T.I.—Sign Sprinkler Demolition Change of Use <br /> IESCRIPTION OF WORK(additional space provided on the back): <br /> M IcWN iota vkA r g- - <br /> MECHANICAL <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 /> A/C—air handling units S 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 Clothes washer <br /> Range hood at <br /> I- Exhaust fan • — <br /> 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 I Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> I Number of Heads ( 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 2'.... OOA WAC. <br /> 74X' W!V <br /> Owner/Authorize en ignature Date -evised 3/2013) <br />