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$0IIdbING 'A ' <br /> UMITA•3 <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 /> 16."4. DY' 28`057g00iv3e.o <br /> SITE ADDRESS: J r�� `� PROPERTY TAX# PERMttT# <br /> I i9c'09 to —.�..- LgDr`19dD/�.�CDU C14 -0I I <br /> P dint of sc ". <br /> LEGAL for new construction: Short Plat/su dlviston Lot No. (attach copy of long legal description) <br /> OWNER 42 to GOAT LLG Phone/E-mail Le Kt) la patikridge kvmes.Gam <br /> Address 17't ZI tOZ tit LL-EVSR:MT 14QV S t71TFi It,City/State/Zip gv4 5u- t ui),4•• ROC(2- <br /> APPLICANT: <br /> OC12- <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 5.04^"4- RS 0.bOv- State Lic.# City Bus. Lic.# <br /> Address S(74441. CIS RUM_. Phone/Email SG ' Qt a 6 ole. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail saws A.1 tt h ave. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f I S2 , S1 <br /> Existing Use of RI''"-- , WA HEAT SOURCE: <br /> Proposed Use or rsuilding_ 4ITACA Mt /M 9' Gas f Electric_ Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family Commercial <br /> ;---Type of project: ✓New _Addition Remodel _Repair T.I._Sign_Sprinkler Demolition Change of Use <br /> iESCRIPTIOpN�O�FgWORK(additionalnspace� ceprovided* o�n-the back): <br /> IvvW 1 W� R0A6 \M t ,,-2 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓NewAddn Alteration_Repair Type of Project: ✓New_Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units '3 Toilet <br /> 1 Forced air systems .. Bathtub <br /> !y Gas piping 3 Lavatory(wash basin) • <br /> 1 Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range 1 Dishwasher <br /> 1 Clothes dryer I ; Clothes washer <br /> I Range hood <br /> 4 Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump I I 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 /> 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 and 296.200• +.•C. <br /> Owner/• •r ed Agent Signature Date (' •3/2013) <br />