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1: 01t.ruN6 1 I <br /> MtV T- 3 <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 /> 2s`osigoo role o0 <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> tdgoq Ic� 't."'A �� s L80S`/9VO/n.)Y-017 UH49-0153 <br /> Pt .lgr.►vR scY t <br /> LEGAL for new construction: Short Plat/su dlvislon Lot No. (attach copy of long legal description) <br /> OWNER 40P-1141-AM GQVR-T LL Phone/E-mail Le Kt 1 IMAM L iCAM <br /> Address 17'tZI. 110140.1.'E1/nbfl t4Ujf SUTg Irti'City/State/Zip gurt4 5u_. t WJ4r. R8t I2 <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 S 'G RS 0.6171, State Lic.# City Bus. Lic.# <br /> Address WA& CS above. Phone/Email S2A'i At' R6ova <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SaAMP A'S ai ov <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1; l S Zr c q tD <br /> Existing Use of Rud".._ W/A HEAT SOURCE: <br /> Proposed Use or[Wilding_ +,tI-A c-i- TrA ► th-6 Gas ✓ Electric_ Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family Commercial <br /> ,hype of project: ✓New _Addition —Remodel _Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> NSIO 1406 VInr r- <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 'Z Bathtub <br /> 2. Gas piping 3 Lavatory(wash basin) <br /> ! Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer / i Clothes washer <br /> / Range hood <br /> 4- Exhaust 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 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 /> 2,2,20/ <br /> Owner/Authoriz t ignature Date (Revised 3/2013) <br />