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U LT I-lam <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 /> i5h2 <br /> }{ 8`os icrop l03 e.ao <br /> SITE ADDRESS: PROPERTY TAX# PERII,IT� n <br /> Id52.I 4*" . SEA Lg'O,S`/9VO/P3y-OP CILIVI-02) <br /> LEGAL for new construction: Short C. • Lot No. (attach copy of long legal description) <br /> OWNER 46P-114141M GDVR-T' I–LC Phone/E-mail Le v Inel vINAM a potic►,C rj dy komes UN% <br /> Address 17 crzi 60 L,E Ve-ST NAN St tTFs 1127 City/State/Zip gtA4t;u_ , L(>>4• aBd I2 <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 5."164" C S 0.bPIP State Lic.# City Bus. Lic.# <br /> Address $(2.44. aS above. Phone/Email Sizw'Q At ab OIR- <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAS a r 1t-hove. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 1 S a, Sct 0 <br /> Existing Use of R.'°"-- WA HEAT SOURCE: <br /> , <br /> Proposed Use yr building_ A AWatAt Gas V°. Electric Other <br /> Building type: so/Single Family _Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> ,–hype of project: ✓New _Addition —Remodel Repair_T.I. Sign Sprinkler_Demolition_Change of Use <br /> IESCRIPTIONO�FWORK(additional space provided on the back): <br /> 145gN 'ROM vkA r I„ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: ✓NewAddn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C–air handling units 7 Toilet <br /> Forced air systems 2 Bathtub <br /> 2. • <br /> 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 /> T— Range hood <br /> 1C-1 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 Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> iNumber 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 /> t Y <br /> Owner/Authorgent Signature Date (Revised 3/2013) <br />