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vNI- 1)-4 <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 /> 28057Q2o/03 z vo <br /> SITE ADDRESS:` 04. L O 1 4,•rte 1)� ss PROLX'°TAN <br /> A 9 vol 0,3 <br /> �O1? PERMIT# <br /> 14-tbqq 7 <br /> Pr4 VF Cr6 ► V <br /> LEGAL for new construction: Short Plat/t�Z 'juvsuodlvislon Lot No. (attach copy of long legal description) <br /> OWNER rbRIvi ►aM CQt* '• LLC. Phone/E-mail Ler het w.ti4 P- igitict ri ely Loiter.CAM <br /> Address 17 t1 Zi tOTIA6LL•-E1JVatI Wet SLATE Itis City/State/Zip errE4 EU_ I W,4. ROO(Z <br /> APPLICANT: Owner ✓Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Sit a' CubMP& State Lic.# City Bus. Lic.# <br /> Address SCuµ@ as above. Phone/Email Scrim, ar RbDue. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail .'ate a Lbove, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4. I S2 t s"."-qv <br /> Existing Use of Ri0.4;~- , VA HEAT SOURCE: <br /> Proposed Use or fsullding_ A 11A C � 1-1,w1421A-5 �, 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 /> RSI#0 ICWW *ROMA Vtitr D- 4- . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: ✓/.ew_Addn Alteration._Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units - '3 Toilet <br /> 1 Forced air systems '2. Bathtub <br /> 2.. Gas piping '3 Lavatory(wash basin) • <br /> I Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range 1 Dishwasher <br /> 1 Clothes dryer - 1 Clothes washer <br /> I Range hood I Water heater <br /> 4, 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 f Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM ! Other: <br /> ,.--- I Number of Heads I 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 296.200A WAC. <br /> ZS'• Zofy <br /> (I/;......) <br /> Owner/Authoriz nt Signature Date vised 3/2013) <br />