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avis-N KI ',3- 1 <br /> PERMIT APPLICATION vow 3- <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 /> 2SOSJCj 'O/03ZO'D <br /> SITE ADDRESS.I O5 r `c"srvk PROZgory 9 v0I n3 Y-0 7 Ct4O CK)ZS <br /> I _f es T. I <br /> LEGAL for new construction: Short Plat/subdivision ons - A, Lot No. (attach copy of long legal description) <br /> OWNER 141I.00iG GOAT L-X-G Phone/E-mail LL z he t tM a n i pati tic ride kvittes.GOM <br /> Address 17 c1Z1 gp L-E11earr 01.(Py 5tnT6 Iv7 City/State/Zip gf1-4 Eu- t boo. 48O(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 aS 0.boVe State Lic.# City Bus. Lic.# <br /> Address SCIM"Q. as al)Dm. Phone/Email Saint tar above. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail .CAAAAP.,Q'S a'130 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK F 15 2 , S9 v <br /> Existing Use of 11.414;-- t/A HEAT SOURCE: <br /> , <br /> Proposed Use ur rsuilding_ P Ti—A C-4450 'IAJI ./ � 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 /> 1491,0 i 7t WAS ukrlr ,'.3 <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 S 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 / { Clothes washer <br /> /— • Range hood r <br /> gC-1 Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <br /> Unit heater J Urinal <br /> Boiler i 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 /> 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 296.200A WAC. <br /> /111./ f-1,3.77/ I/2 , <br /> Owner/Aut igen Signature Date 'evised3/2013) <br />