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I <br /> PERMIT APPLICATION VO« K �� <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$`os-gmo/03z.at) <br /> SITE ADDRESS. PROPERTY TAX# PERMIT#_ <br /> os?I ► ift14. INS Lgm 9 Po/n.) vn C.14_12 -00Z <br /> � vF 19E tv <br /> LEGAL for new construction: Short Plat/su dlvislon 2 ! Lot No. (attach copy of long legal description) <br /> OWNER 1408 4t.AM Phone/E-mail t_E z 11e.)viN of y\ e. patictc rj t e Iwwir..r.cam <br /> Address l7'1Z1 ISD 6►.L,EVeat-r I9LQY. St9iT6la,City/State/Zip gt7r145U— , 1,+V . R8n(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 Sit RS 0.bOn, State Lic.# City Bus.tLic.# <br /> Address SCuoIt CU. ab 0VQ. Phone/Email Sam tarabove° <br /> TENANT BUSINESS NAME ---ICONTACT FOR PERMIT <br /> Phone/E-mail Saws a 401 rive. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .77-1.3 8 5 2 <br /> Existing Use of Ri,❑ao.._ tstt/A rr�A� HEAT SOURCE: <br /> Proposed Use ur bunting vTVAC-450 Gas ✓t Electric Other <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 /> eESC RIPTION OF WORK(additional space provided on the back): <br /> N 1t W ) I4ONE vkA <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 4. Toilet <br /> I Forced air systems Z Bathtub <br /> 2 Gas piping S' Lavatory(wash basin) <br /> Water heater - / Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range —� Dishwasher <br /> l Clothes dryer / 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 ( Grease trap <br /> Ducting Roof drains <br /> Other ( Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: <br /> 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• . AC. <br /> fer 7• zf' ec/.V <br /> Owner/Authorr' Agent Signature Date (Revised 3/2013) <br />