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RVR-PiN& 'Dj <br /> VIA D-2. <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 /> 25057(We'103L D'D G, <br /> SITE ADDRESS: l- "4 DYE= PROPERTY Lkari9�/n.))Y-0D PERMIT e Sgoq'O35 <br /> Pte� `''ZN R`51� w <br /> LEGAL for new construction: Short Plat/subdivision t Lot No. (attach copy of long legal description) <br /> OWNER L,M GQ1,111— 1-1-G Phone/E-mail Le z het vv,CVA L pati PtC.ri tty kinieS.cam <br /> Address 17 aZ1 Q14IWEA.1•,it?btT c4I,VY SL tTE IA7 City/State/Zip gpr 4 6t.L 1 Loa,-. ROO(2 <br /> APPLICANT:_Owner ✓Owner's Agent _Contractor _Contractor's Agent T Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR $. 't a's cuboV'P> State Lic.# City Bus. Lic.# <br /> Address SCIAA.Q. MS R.1)002- Phone/Email S Z44 Ar a b 0V°t. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail VaVV'P.--CO. 1 -12ov <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '} 1 Tz 1 VR 0 <br /> Existing Use of Rina.— WA HEAT SOURCE: <br /> , <br /> Proposed Use ur building_ ,ek -A S 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 /> M) ICWN wikx6 \or 1)-2 <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 /> NC-air handling units 3 Toilet <br /> Forced air systems 2 Bathtub <br /> 1'Z. Gas piping ?j Lavatory(wash basin) • <br /> I Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range ( I Dishwasher <br /> Clothes dryer <br /> In { Clothes washer <br /> A- Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 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. :• . <br /> �-,� - �/� I �2 <br /> Owner/Authorient Signature Date (Revised 3/2013) <br />