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RVI (*( .T4 <br /> vUr <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 /> 28051gp0103z171) <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> tO5O , t5 ��' OR. sS Zrapt vo/n3y•vv 040g – 27- <br /> Ptprv.► scr I <br /> LEGAL for new construction: Short Plausu division Lot No. (attach copy of long legal description) <br /> OWNER tittertiLAM Q7VR-T' LAX- Phone/E-mail Le z he! is aN e pati o rl d9e Ivn 4 S•(,am <br /> Address I7CtZI (',O 1,L-0EVMrtt t4bQY. StitTT IIV City/State/Zip g745u-- , WR• ROOt 2 <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 a' Cubo1re State Lic.# City Bus. Lic.# <br /> Address Stout as a.boV. Phone/Email SGM►t ar Qhotfe. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S'AAMP.-of above. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK tSZ, SI O <br /> Existing Use of t4/A HEAT SOURCE: <br /> Proposed Use or building411-A CA-1*S> -11,1AA.A4CAAS <br /> Gas V.'. Electric Other <br /> Building type: "Single Family Duplex "Townhouse ✓Multi-Family _Commercial <br /> ,--Type of project: V.-New _Addition _Remodel _Repair_T.I._Sign Sprinkler Demolition Change of Use <br /> /ESC RIPTIONO.FWORK(additional space provided on the back): <br /> 1461.0 1k9N i4OXI6 UJJtT' 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 /> A/C-air handling units '3 Toilet <br /> / Forced air systems 2 Bathtub <br /> Z. Gas piping 3 Lavatory(wash basin) <br /> —] Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer / ; Clothes washer <br /> / Range hood <br /> Exhaust fan • 1 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 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 18.27 RCW an OOA WAC. <br /> I/a <br /> zoly <br /> Owner/Authorized,/'nature Date (Revised 3/2013) <br />