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1 )1( w& F. <br /> -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 /> 2805-/g00/03 z.ao <br /> SITE ADDRESS: .� ,1 0� PROPERTY TAX# PERMIITT# d <br /> 1"��p►i of 6Gr• - <br /> LEGAL for new construction: Short Plat/subdlvislon - i, Lot No. (attach copy of long legal description) <br /> OWNER NIORMLIM GO I-LC Phone/E-mail L z her►M MIA e C ri die koctits.GOM <br /> Address 171Zt tp 1d.-Eveestf sot Sm.&Il)City/State/Zip ION EU-- t I,Ih4• ROC(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 S"^'t 14 0.1001Pe State Lic.# City Bus. Lic.# <br /> Address Sam VS Mb 002. Phone/Email Scuff Ar Q b We <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAS ar a,bow_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t' - 02.1— <br /> Existing Use of R""'".-- N/A HEAT SOURCE: <br /> + <br /> Proposed Use of tsutiding_ A.trAc-i-l-sw I✓, Gas V°. Electric Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family Commercial <br /> ---hype of project: ✓New _Addition Remodel _Repair T.I._Sign Sprinkler Demolition Change of Use <br /> iESCRIPTION OF WORK(additional space provided on the back): <br /> R610 IC") W3VISIT" E-3 <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 1 Gas piping g Lavatory(wash basin) • <br /> / Water heater / Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> / I Clothes dryer / i Clothes washer <br /> Range hood ___,/ Water heater . <br /> S Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove r---- Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER/ 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 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 29 OA WAC. <br /> 1/a <br /> Owner/Autho ent Signature Date (Revised 3/2013) <br />