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Niti>twt, 3"- <br /> IV t1- T-4- <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 /> 2805-/gD0 i v 3 e.vo <br /> SITE ADDRESS: PROPERTY TAX# P R I # a <br /> tog ll 0 t05 9-� DR LB'DS`/9GID/P3Y-017 C.ft0cl` 2& <br /> ���of cr <br /> LEGAL for new construction: Short Plat/su6dtvislon Lot No. (attach copy of long legal description) <br /> OWNER NIT-114141M Q7VP. 1-1•C Phone/E-mail Le he.'MAN% P- toltiPtcrjdFknwlt!s.Gam <br /> Address 17¶ZI 1141451.1.-&WittT Wei 5t71Tg 1127 City/State/Zip erri4 514- t WA'. get)12 <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 SQ'"'G a'S 0.bpVe State Lic.# City Bus. Lic.# <br /> Address $WA. CU CO 011 Phone/Email SGM►t A.f ail Doe <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAMA A.r Ot.b 01/e, <br /> ` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK A t S2., 54 0 <br /> Existing Use of RI„".._ VA HEAT SOURCE: <br /> ` <br /> Proposed Use ur building_ 4 AC4 4 .6 Gas Nr. 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 /> .0ESCRIPTION OF WORK(additional space provided on the back): <br /> MR0 -tcwkl Wise u i r T-4 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: ✓lew_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units g Toilet <br /> 7 Forced air systems 2, Bathtub <br /> 'L, 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 /> "7- 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 I 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 and 29. '0;WAC. <br /> 9. if •A? /yo <br /> 0 . <br /> Owner/Aut riz ent Signature Date (Revised 3/2013) <br />