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15)UI-DcNt, ' F` <br /> 1)tvct F-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 /> 28`o5Jgoo/03z.DO ,/ q 6 <br /> SITE ADDRESS:.05 n L ` ik,,r,,,, op, $ PROZ DST`A q Ev/r73 y..01:7 PERC/M`I # <br /> P —V( l <br /> LEGAL for new construction: Short PI Psu6dlvisionvc Gr t Lot No. (attach copy of long legal description) <br /> OWNER 14Ce 4t•3 C GOVRT I-LC Phone/E-mail LL z he.i vo, 4A la 1>titi l rj die komt.r.WM <br /> Address 17'I ZI to-rg t.-evemi Nob jV. S utTE 11Z7 City/State/Zip guiv EU... t Wi4. ROO(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 5.134"4- vt5 0-111011e State Lic.# City Bus. Lic.# <br /> Address SWA& C' R.b o111Z Phone/Email SU** tar R b ote. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail .C.AAA4,a r AA ow_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 I S21 ..s--q P <br /> Existing Use of Rini"— t`I/A HEAT SOURCE: <br /> , <br /> Proposed Use or building_ 4 'A S AS • Gas ✓ Electric_ Other <br /> Building type: ✓Single Family —Duplex ✓•Townhouse V'Multi-Family _Commercial <br /> ,-hype 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 /> 14 1-C WN 'ROM vor F4 <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 3 Toilet <br /> Forced air systems 2. Bathtub <br /> !"L 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 <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 f Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I 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 296.200A WAC. <br /> Owner/Aut • /Agent Signature Date (Revised 3/2013) <br />