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$V►L-4)(0G `G , <br /> V JIT &-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 /> '24`057c/c20 103 Z 179 <br /> SITE ADDRESS ! ©q. 11:6111 pI �_ PROZrD�A�q r/ '3'Qv PERMIT# <br /> C)(40c1 -050 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LM C 911M- I-LC Phone/E-mail Le IleJ w t e paeiAt rl tly kome.r.Gom <br /> Address I71Zi i...E/ &t'f c41,()y SUIT f 11Z7 City/State/Zip gor}Gam. r wi4• R!30(2- <br /> APPLICANT: <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 Sit a'S sa-b OVID State Lic.# City Bus. Lic.# <br /> Address S GlAAkt OS abMa Phone/Email SCfAA ar above <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail Sates a r a.b vv_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4- 1 S2 i S R 9 <br /> Existing Use of R.or"'- WA HEAT SOURCE: <br /> , <br /> Proposed Use ur tsuilding_ A 41. "11, M • Gas ✓ Electric Other <br /> Building type: ✓Single Family _Duplex ✓Townhouse ✓Multi-Family Commercial <br /> r--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 /> 14E10 I ) 140j6 ukn r &-5 <br /> r 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 3 Toilet <br /> / Forced air systems Z Bathtub <br /> Z. Gas piping 3 Lavatory(wash basin) . <br /> / Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> / Clothes dryer / i Clothes washer <br /> / Range hood rer-e-er <br /> 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 I 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 and •=. "IA WAC. <br /> F. Z3. Zvig (lam <br /> Owner/Au or' -:Agent Signature Date (Revised 3/2013) <br />