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()II-DIN& 'AI <br /> )P3w 1 G <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 /> 1 5r- "2:8125/Cj00/03 Z.OV <br /> SITE ADDRESS: o 2 PROPERTY TAX# PERMIT# , <br /> t dI. _ 5.e. LB'or/9 ov/P3 Y-017 CA LI Oct-0I I- <br /> P��. of cr. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER rteergtAM cot) - 1- -C- Phone/E-mail 1$z het 1M aw e tati Aic ri 4e iww'es.GOM <br /> Address 17(121 &mat-EVearr Hwy 5 O 1127 City/State/Zip egri4 ELI... t 104. 480I?- <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 S 'G cti5 0.br State Lic.# City Bus. Lic.# <br /> Address $COQ. CIS MbOM- Phone/Email gawk as above. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail $D.wl-a r AA ove, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1 i g4,. 882- <br /> Existing Use of Pi.i -- WA HEAT SOURCE: <br /> ` <br /> Proposed Use or building_ +h-llA e-4sm► p At • Gas ✓ c ElectriOther <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 /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MO fIQ i•OME myr A-6, <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 ?, Toilet <br /> 1 Forced air systems Z Bathtub <br /> 2.. Gas piping '.j Lavatory(wash basin) . <br /> 1 Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Li Clothes washer <br /> I Range hood <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump 1 I Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I 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 -. <br /> g 7 Li9 4 /L1 VO'" ' <br /> Owner/Au ori,-- Agent Signature Date (Rens-.3/2013) <br />