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R04>ti4 6, <br /> PERMIT APPLICATION Viicr 2 <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$p51 goo/03e.vv <br /> SITE ADDRESS: t.vs, PROPERTY TAX# y. PERMIT# <br /> t70/ <br /> P��!�.�iP0 of sC• <br /> LEGAL for new construction: Short Plat/suodlvislon Lot No. (attach copy of long legal description) <br /> OWNER ftealtloWt. COI.' I-1-G Phone/E-mail LE zMel w aM a pa.l iP c rj rle IWMP 'GOAn <br /> Address 17 R Z1 gp l,L,EVsei:4— t41VV. S(Mg 1107 City/State/Zip RV'114 5u, r km, • Qv V(Z <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 Q'S CuboVt State Lic.# City Bus. Lic.# <br /> Address SIAM*. CIS ab 0 Oa Phone/Email ErtiAtt CU a b DUB <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S'aANt-a r Ot,b we <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t I S Zt Sq II' <br /> Existing Use of R„i'.+"..— VA HEAT SOURCE: <br /> Proposed Use ur tsunding_ A.U-A p I44\1- t� Gas✓` 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 /> 1451.0 1CWW i4o1a6 VoYt El. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: ✓NewAddn __Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 3 Toilet <br /> / Forced air systems Z I Bathtub <br /> 2Gas 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 / Water heater <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump f � Backflow preventer <br /> Unit heater I Urinal <br /> Boiler i Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove ( Grease trap <br /> Ducting Roof drains <br /> • <br /> Other 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 • struction <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. .•' A . <br /> it/ a-- <br /> ft 2 ► ZOO <br /> �� Date (Revised 3/2013) <br /> Owner/• ,tho a Agent Signature <br />