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1 i WI,pik)G .• 'It <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 /> 2•SosJ(Ma/03Z.Pi? <br /> SITE ADDRESS: 1.5}"' PROPERTY TAX# PERMIT# <br /> I "525 ►k--vim• ss aTos-/9vo/t2.3Y-Dn GI LEO 9 -02.7 <br /> Fyt-gypo cc scr• <br /> LEGAL for new- construction: Short Plausu division Lot No. (attach copy of long legal description) <br /> OWNER litnst4LL GI:71V1-LC Phone/E-mail LE z he t W aw e. ?ad A C rl ay komm GOM <br /> Address I7aZ1 6DT L-E'Ve o`o- l4WV SttTE IAV City/State/Zip RD 614.- t Wr4• ROO I 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 .5114"t• State Lic.# City Bus. Lic.# <br /> Address Sam& as Q•b oVe Phone/Email 5 rt#4414 ar Q b oLe <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail . D.M4-a r AA ov . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 11 BRI vv 2 <br /> Existing Use of R..n.4:.,. tVA HEAT SOURCE: <br /> ` <br /> Proposed Use yr building_ AMA c44.54N, --Cv'I ,1itAt Gas V" Electric Other <br /> Building type: ✓Single Family —Duplex ✓Townhouse ✓Multi-Family Commercial <br /> --sype 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 /> N. >v 140/416 u n-r 1-7 <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 Z Bathtub <br /> Z Gas piping 3 Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> / Gas range / Dishwasher <br /> 1 , } Clothes dryer / Clothes washer <br /> Range hood <br /> 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/ SUPPRESSION SYSTEM Other: <br /> I 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 constructio• <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 /> Owner/Authorizedignature Date (Revised 3/2013) <br />