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fgUR b NG `H' <br /> UMW ►t-2.. <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 /> '2-8`051C/00/93e.ao <br /> SITE ADDRESS:1421 .105Th r ` SE PROZrp TANvoi 1,3 y-QU PEC LID CI IT# -® S3 <br /> Pmt iN!�►t scr <br /> LEGAL for new construction: Short Plat/su dlvislon Lot No. (attach copy of long legal description) <br /> OWNER I 1.,L COt*T 1-1-C+ Phone/E-mail LCs het Waw e- tatiCix ri de komm GOM <br /> Address 17'Zi tQ w.-Eeatr r4j4)'f. SUtT6 Iry City/State/Zip gp Eu_ t 1,04• at3d I 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 SWA^'G RS 0.bWe State Lic.# City Bus. Lic.# <br /> Address SWA. liS %6m. Phone/Email Sawe- At R 6OV?_ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail sA ar above_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ' i S Z, 5 a <br /> Existing Use of Biala,,-- %VA HEAT SOURCE: <br /> ` <br /> Proposed Use or building_ A, A p 71,144...07146Gas N''' 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 /> iESCRIPTION OF WORK(additional space provided on the back): <br /> 1451.0 "t1 W ) 1401.X6 UktIT' M-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 /> A/C—air handling units g Toilet <br /> / Forced air systems Z. Bathtub <br /> 2„ Gas piping 2 Lavatory(wash basin) • <br /> / Water heater Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> / ' Clothes dryer / Clothes washer <br /> 4 Range hoodI '^'a+eA h ae ter <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 Grease trap <br /> Ducting Roof drains <br /> • <br /> Other I Medical Gas <br /> SPRINKLER I.SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> ..,iereby 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 R - = 96.200A WAC. <br /> .0 f. ..3- lot y VD_ , <br /> Owner/Auth"Ag- t Signature Date 'evised 3/2013) <br />