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T ?uU4cub ' b ` <br /> v►oirb -s <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 /> 2So5/goo/03e.OD <br /> SITE ADDRESS:I 04, (4, ,(,,rte PROPERTY TAX#voic7,)y.017 EMIT# 381 <br /> tvp-ipovc scr• ► <br /> LEGAL for new Short Plat/suodlvision Lot No. (attach copy of long legal description) <br /> OWNER Il t'ttAm col/ ta.-C Phone/E-mail L z Kelm a.' B. Ia.ei A ritlr 6940.s W M <br /> 80IZAAddress 17ciZ % L.I-EWIs'rr WO/. 5t71T5 I17 City/State/Zip 101-14 Elk_ t Wi4. (00(2- <br /> APPLICANT: <br /> PPLICANT: 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 5.1:1444t• tf;S cubov- State Lic.# City Bus. Lic.# <br /> Address Sam& as' RUM. Phone/Email g polAtt Qr x i ove <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail saw at a,b ovp <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK i' I S Z tC- t P <br /> Existing Use of R„itAo... /A HEAT SOURCE: <br /> ` <br /> Proposed Use ur building_ A<TTA C4 /84Gas Ne''. Electric_ Other <br /> Building type: ✓Single Family Duplex ✓Townhouse V'Multi-Family Commercial <br /> - Type of project: ✓New _Addition _Remodel Repair T.I.,Sign Sprinkler Demolition Change of Use <br /> JESCRJPTION OF WORK(additional space provided on the back): <br /> 1451#0 1W 10 Wm )kflT' D-5 <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 '1 Toilet <br /> —__I Forced air systems 2. Bathtub <br /> 'Z Gas piping 3 Lavatory(wash basin) <br /> I Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> I Clothes dryer ___I iClothes washer <br /> Range hood I Water heater <br /> 4--- 1 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration ( Floor drain <br /> Woodstove i Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> .-, I Number of Heads I Other: <br /> .,iereby 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 296.20 WAC. <br /> z3• �iy lie <br /> Owner/Authorie t Signature Date (Revised 3/2013) <br />