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IVIL )& ' X41 <br /> 0IJIT. A-4 <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 /> 55 '` br 2805/goo/Iv3e.ao <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> I 19C° 13_ 1-Er--'1- z. ZroS`/9 cal 03 Y-017 C • - ô ? <br /> LEGAL for new construction: Short Plat/subdroms on ski i a I,(,/, Lot No. (attach copy of long legal description) <br /> OWNER I h4L,LM CQi, (-LC Phone/E-mail Le lei vv,wfn ?a.t i i,L r+d9e 604P-S% <br /> Address 17 C'ZI towst.l-E1/eQ:$I1 Nrivit 5121T&UV City/State/Zip g12114 EU._ t U)A•• q/30(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 5.44^"to a'S Cubot/1 State Lic.# City Bus. Lic.# <br /> Address $t7M". cir ab Ma Phone/Email Srd CO. Q 9 OlI <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail Samar al ow <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK T !CZ, 59 0 <br /> Existing Use of R„ibrr..- VA HEAT SOURCE: <br /> Proposed Use ur building_`A<Tr*C1t1 'w 1 /ftAt • Gas ✓ Electric Other <br /> Building type: ✓Single Family —Duplex ✓Townhouse ✓Multi-Family Commercial <br /> -Type of project: VNew _Addition _Remodel —Repair T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> NtSLo iI W 'ROM Mir A- 4 <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 /> A/C—air handling units 'j Toilet <br /> 1 Forced air systems !. Bathtub <br /> 2 Gas piping 3 Lavatory(wash basin) • <br /> I Water heater Shower <br /> Gas fireplace I I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> t Clothes dryer I ; Clothes washer <br /> I Range hood .fli—r-Srerrrerater <br /> 41. Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump 1 j Backflow preventer <br /> Unit heater ( Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> • <br /> Other Medical Gas <br /> SPRINKLER I 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 constr ction <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 296,2... ..... <br /> I <br /> / f Z11 ZOIV <br /> Owne rued Agent Signature ' Date (Revised 3/2013) <br />