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Ng-DtN6 ' F <br /> ur\Mr F-t <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 /> 2825 gt20/O3eaD <br /> SITE ADDRESS: r PROPERTY TAX# PERMIT# q <br /> t '32 rl-r`re�. ' LgD.c-j9vD/'3Y-D17 �'i11-109' ®59 <br /> LEGAL for new construction: Short PIat/su�6dlvms on 2,i C.• e w Lot No. (attach copy of long legal description) <br /> OWNER ItRN1.4M COVPTPhone/E-mail to s hel p GLA a pati PC rj r e h ititr.1,004► <br /> Address 17'Z1 t4MN SVag 11,City/State/Zip guru t 14)A, (OW t <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 S ^'G RS 'Mb(Are State Lic.# City Bus. Lic.# <br /> Address SW4. C' ab OtAa Phone/Email grove. ar Q b Due. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S. 4.-Q.r 04.1 OV. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $_Z - r OZ.+. <br /> Existing Use of H/A HEAT SOURCE: <br /> Proposed Use or tsullding41A c4.1450 71,-m\st4aveGas 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 /> .ESCRIPTION OF WORK(additional space provided on the back): <br /> NS1,0 ICWN }&oto )k -r F'- pg 14-03 01 0 <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 g- Toilet <br /> / Forced air systems Bathtub <br /> Z Gas piping Lavatory(wash basin) • <br /> / Water heater / I Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer _� Clothes washer <br /> Range hood <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump — <br /> / ( 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 I Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM 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 lam 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. r c\AC. <br /> 9 -63 - wiy <br /> Owner/Authorized nt Signature Date ed 3/2013) <br />