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til j 1zr' <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 /> 241257gv0/93z.ao <br /> SITE ADDRESS: P RMIT1isUR . sjPROPERTVTAXtI <br /> tann.,�on a (a°(7_0Z3 <br /> Pt• .wo of sGr <br /> LEGAL for new construction: Short Plaussudmsion Lot No. (attach copy of long legal description) <br /> OWNER 1•AMr <br /> ' LLG Phone/E-mail L z het main q e ixtei AC rj ii a RO MP c cam <br /> Address 171ZImutat-I ar- r t4w)V• s tag lIP City/State/Zip guru Eu- r w,4• RBd(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 /> 1 <br /> CONTRACTOR 5. 'G RS 0.bove State Lic.# City Bus. Lic.# <br /> Address Scum OS above. Phone/Email 512,444 Ar Ot b oV. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail s'AAApt,a.r a'b ov' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK lf. Z 3 f)6 S 2. <br /> Existing Use of R'1"a4.- t4/A HEAT SOURCE: <br /> ` <br /> Proposed Use ur IduudingMTA CA4'5 413A6 ' 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 /> iESCRIPTION OF WORK(additional space provided on the back): <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 /> NC—air handling units Toilet <br /> / Forced air systems 2 Bathtub <br /> Z • <br /> Gas piping S I Lavatory(wash basin) • <br /> / Water heater / Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> I Clothes dryer / i Clothes washer <br /> / Range hood <br /> r Exhaust fan • T 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/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> ._oereby 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 /> ff . 2.2- Lo/y 1/2, <br /> Owner/Author' ed •--:ntSignature Date -- ed3/2013) <br />