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Y <br /> Bt?1 t,t111 r <br /> PERMIT APPLICATION AIIr J= <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 /> 2gos-igoo iv3z.00 <br /> SITE ADDRESS: �� PROPERTY TAX# RMIT 11 <br /> IOsO2 t5 EN ss L&'os;`/9v,D/n.�Y-Ov L L1 q-0? <br /> �t'� i$�ni ��E w <br /> LEGAL for new construction: Short Pit/subdivision dlvislon t Lot No. (attach copy of long legal description) <br /> OWNER fte1141411MGDVRA— LU • <br /> Phone/E-mail t o t,te.lviN alA I Pati CrjCI eiWititr.WM <br /> Address 17 WI tQ 1i ,(,- &Warr t4W4fiy. MTG.I1Z7 City/State/Zip 10114 EU- t WA- c(80(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 Sit State Lic.# City Bus. Lic.# <br /> Address Sam"Q as aboV42_ Phone/Email SGW a above. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SA t-at ai ov <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ Z-1( t 5s2, <br /> Existing Use of Run"-- tst/A HEAT SOURCE: <br /> ` <br /> Proposed Use ur building_ 4TrAc-t-1.5h t !t-tnt`1 Gas ✓� Electric Other <br /> Building type: ✓Single Family _Duplex ✓Townhouse ✓Multi-Family Commercial <br /> hype of project: ✓New T Addition _Remodel u Repair T.I._Sign_Sprinkler Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 8510 1CW IQ 14,01a6 UL YT' J-- ' <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 Toilet <br /> / Forced air systems Z. Bathtub <br /> 2 r Gas piping .S' Lavatory(wash basin) <br /> / Water heater / Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> / Gas range / Dishwasher <br /> / Clothes dryer / Clothes washer <br /> 1,-- Ehood <br /> Exhaust <br /> st fan • Sink(service/bar/mop/etc.) <br /> Heat pump / 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 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 78.27 RCW and 296.200A WAC. <br /> 9A <br /> �/j <br /> Owner/A hor' ed Agent Signature Date (Revised 3/2013) <br />