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PERMIT APPLICATION VN►r . <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 /> 2.805-0100/03 e. <br /> SITE ADDRESS* PROPERTY TAX# P ?lb# <br /> [0513 1 "' ► s _ ZSTIP/9tx)/n.�Y-On ( ®� <br /> LEGAL for new construction: Short PI tJsuodtvis on "'Lys �1 a �(/. Lot No. (attach copy of long legal description) <br /> OWNER itelTV. Z tot) LL Phone/E-mail Le Z het ma r\ a pa.lri is rj d9C kvmes.cam <br /> Address l7ZI i-EWir rr RIVY• Swim Ira City/State/Zip gort4Gu_ t (Jdr. Re ( <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 State Lic.# City Bus. Lic.# <br /> Address scout us' ab°Oa Phone/Email ScuME As Q b DI/e. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail QA/V -Q 1 t5t <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORISZsqv <br /> Existing Use of R"""-- NA HEAT SOURCE: <br /> Proposed Use ur tsutldingf AC-44.S10Gas ✓ Electric other <br /> Building type: ✓Single Family _Duplex ✓Townhouse ✓Multi-Family Commercial <br /> hype of project: VNew _Addition —Remodel _Repair T.I. Sign Sprinkler Demolition Change of Use <br /> )ESCRIPTION OF WORK(additional space provided on the back): <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 /> 2., 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 /> Rangehood <br /> 40-1 Exhaust <br /> st 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 /> • <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: <br /> 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 and • •C. <br /> Owner/"Pr P.-Agent Signature Date ,ised 3/2013) <br />