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taut toNei 'b ' <br /> UI\)tr0- 1 <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 /> 2Sosnoo 1v3Z.DV <br /> SITE ADDRESS: PROPERTY TAX# PERMIT <br /> S ; <br /> / / • 1. ‘ : - ZB'ov a ex 21 n..?)4 OP • 472 <br /> IT <br /> LEGAL for new construction: Short Plat/subdivis on 21N R1 f IV Lot No. (attach copy of long legal description) <br /> OWNER 4=141.1 Gov - LLC. Phone/E-mail LESh.e.1 MAM e- p.gitict ridykoc,le.S•GOA4 <br /> Address 17 cIZI 69 6LL'EVe?.&tf t 4►(N. g Virg ITV City/State/Zip gVrN 51k-- , 1,Vi4.. 48V(2- <br /> APPLICANT: <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 a'x aboV'e State Lic.# City Bus. Lic.# <br /> Address Sam& as QUM. Phone/Email Sr A•r Q 1)Dye <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAS a r ctio Ow _ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK * 16 9 i 615 Z <br /> Existing Use of R„n.4;.._ WA HEAT SOURCE: <br /> , <br /> Proposed Use yr Pudding_ ftA•C44.5 I/Vi '� Gas ✓A 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 /> iESCRIPTION OF WORK(additional space provided on the back): <br /> 14 1-CWU i4o►6 \kJYI' b-i <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 '3 Toilet <br /> 1 Forced air systems Z Bathtub <br /> 2 Gas piping ?j Lavatory(wash basin) <br /> 1 Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range 1 ( Dishwasher <br /> I Clothes dryer 1 Clothes washer <br /> I Range hood 1 Water heater <br /> .q.. 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 Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other: <br /> 1 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 regul-”.•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 296.20s' ""• <br /> '''' ''' f'' ZI' Zig Y (/2 <br /> Owner/Au or =;Agent Signature Date ' ed 3/2013) <br />