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VWti & -1— <br /> PERMIT <br /> 2PERMIT 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.S 051 goo1o3L.PO <br /> SITE ADDRESS: 1405, r•05/1 P-1 s 1PRT3o PC 140C1-010 <br /> l4 0/ 1 0 <br /> 6Pte� i 2ini;`4� w• 1 (.� `� <br /> LEGAL for new construction: Short Plat/su6dlvislon I Lot No. (attach copy of long legal description) <br /> OWNER 402.1/4144-e- GOMA- I-LC Phone/E-mail Le z het YIN Gt/A e i C ri de lowier.&am <br /> Address 17'I ZI tQ rJ l-eveafl mot S(tTt Iffi7 City/State/Zip gni Eu- r Lod,• q 1 t2(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 S 't RS 0.b0 State Lic.# City Bus. Lic.# <br /> Address SaMat CIS a6002- Phone/Email SaM►'Q at R b ove. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SalA4 ar a.bove, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ (S 2, S q C• <br /> Existing Use of R.'t""— ,W/Aj�� HEAT SOURCE: <br /> Proposed Use Lir building_,AtTr t,�ai.1•EE� 1 � M'� Gas ✓. Electric Other <br /> Building type: ✓Single Family _Duplex ✓Townhouse ✓Multi-Family Commercial <br /> ,-type of project: V.-New —Addition _Remodel —Repair_T.I. Sign_Sprinkler_Demolition_Change of Use <br /> iESCRIPTION OF WORK(additional space provided on the back): <br /> 1451.0 "ZEN Ww6 OAT" G-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 /> NC-air handling units 3 Toilet <br /> Forced air systems 2 Bathtub <br /> /Z Gas piping _4 Lavatory(wash basin) • <br /> / Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> Clothes dryer / Clothes washer <br /> Range hood <br /> AF—I 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 f Grease trap <br /> Ducting Roof drains <br /> Other 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 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 200A WAC. <br /> I 9,23. 12/L.,A. i/2 , <br /> Owner/Auth, ,agent Signature Date (Revised 3/2013) <br />