Laserfiche WebLink
Pt)1LbNNGVar A-2 <br /> �A <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 /> IG-44.. Dv SG- 2gos7gvoiO3e.OV <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> IoG 05 :fir jd L8'v i9r'/e�.��O1, CIt#©'-OID <br /> P���{v►.1 of �.r. <br /> LEGAL for new construction: Short Plat/su6dlvislon Lot No. (attach copy of long legal description) <br /> OWNER titellaTAM cot/RA" LLC. Phone/E-mail Lez helms:4N e i C ri£L I\O Mes toM <br /> Address 17ciZi VQ1LL-Eve $I1 t44N sut f IRS City/State/Zip gm-145u_ 1 WA- Q017(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 Sa'l't RS alItm r State Lic.# City Bus. Lic.# <br /> Address S CIAAPP. as abo112. Phone/Email SaAN'e As Awe. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S•AM4 ar A.10OW_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK * 15 z-,59 O _ <br /> Existing Use of R.,ita:..- WA _ HEAT SOURCE: <br /> , <br /> Proposed Use yr building_ 4TrA C-44•SiE *6 � Gas ✓ Electric Other <br /> Building type: V'Single Family —Duplex ✓Townhouse VMulti-Family Commercial <br /> ,--Type of project: V.-New —Addition _Remodel _Repair T.I. Sign_Sprinkler_Demolition_Change of Use <br /> )ESCRIPTIOpN�OFWORK(additional space provided`onothe back): <br /> Ivv 4) - WIQ .19014x6 vky l A.2, <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 /> —1 A/C-air handling units Toilet <br /> tl Forced air systems 2. Bathtub <br /> • 2 Gas piping j Lavatory(wash basin) • <br /> 1 Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range 1 Dishwasher <br /> t— Clothes dryer 1 i Clothes washer <br /> Il Range hood <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> I Heat pump 1 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 /> 1 Number 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 an• .• i s• WAC. <br /> Zi- zviy <br /> Owner/ ' ized Agent Signature Date (Revised 3/2013) <br />