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RUtI✓>thi6 I' - <br /> 15 <br /> PERMIT APPLICATION 1MT ^ <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 /> i54-'►, 2805/goo/03L PO <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> t C 517 -' ' SS 4 M 9 DO/P.1 Y-op ( i' 0c( 'OW <br /> LEGAL for new construction: Short Plat/su division C. • Lot No. (attach copy of long legal description) <br /> OWNER LL UMI 1-L Phone/E-mail Lezhetv&Ct4A e- patiActr1dyiolwter•Gobi <br /> Address 171 Z t�0 1.1,E%/ U`IT t401 St TTs 1112 City/State/Zip guruEu.- r loaf- 4vd(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 C 't et 12•b0v-t State Lic.# City Bus. Lic.# <br /> Address $CIM"Q cis ab oVlz Phone/Email Sub* et above <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail ,S-A a r pt,b OW_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 15 Zi SQr) <br /> Existing Use of R";t.+r~— VA HEAT SOURCE: <br /> Proposed Use or rsuuding_ AIA C41 TV'Wi . � Gas N./. Electric Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family Commercial <br /> ,— ype of project: ✓New —Addition _Remodel Repair T.I._Sign Sprinkler Demolition Change of Use <br /> .ESCRIPTION OF WORK(additional space provided on the back): <br /> RRO 1C WN 'WAS Ui T' I-5 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: View 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 /> Z Gas piping Q✓ Lavatory(wash basin) . <br /> / Water heater Shower <br /> Gas fireplace ( Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer / i Clothes washer <br /> f Range hood �_—H Wa4 -i eater <br /> 77 Exhaust fan • 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 I Medical Gas <br /> SPRINKLER I 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 /> 7l� <br /> i <br /> 9.L3• tD/y <br /> Owner/Auth• .•ent Signature Date (Revised 3/2013) <br />