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Wu-t tN& 1 Ii J <br /> uIt r N-5 <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 /> Zgos qv°1 osz09 <br /> SITE ADDRESS: — PROPERTY TAX# E MIT <br /> 1426 105Th P ) 5•t- Z8'o.�/9v0/nPc <br /> iY-on I U9—OaL <br /> LEGAL for new construction: Short Plat/ <br /> ste�u6dtvtslo,,, �n i* 1:".."• . Lot No. (attach copy of long legal description) <br /> OWNER t•WIALLM GOVRT LLG Phone/E-mail Le r het vita.A L dal iAC ri dy knwies•CAM. <br /> Address 17 921 Qpius.L'evnt4 - l4WY• St9tT61t 7 City/State/Zip gV EU- t LJ,4. R8oI2. <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 $M^^'t RS abIDPP, State Lic.# City Bus. Lic.# <br /> Address Smutas above. Phone/Email SaMi'Q Ar ab Due. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAAA4 a pt'bo <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK c i 5.21 5ct P <br /> Existing Use of Rett.+:.... WA _ HEAT SOURCE: <br /> , <br /> Proposed Use ur tsullding_ A.TrA C4-1•5 --DWNS Gas ✓ Electric_ Other <br /> Building type: ✓Single Family —Duplex ✓Townhouse V'Multi-Family _Commercial <br /> ,----Type of project: ✓New _Addition _Remodel _Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> .ESCRIPTION OF WORK(additional space provided on the back): <br /> 14510 ICWN *ROM vLflT 1-1-3 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓NewAddn __Alteration_Repair Type of Project: ✓NewAddn _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, GasProject • Lavatory(wash basin) . <br /> / Water heater Shower <br /> Gas fireplace i Kitchen sink&disposal <br /> Gas range ___J Dishwasher <br /> ` Clothes dryer / Clothes washer <br /> Range hood <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <br /> Unit heater j Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: <br /> 1 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 WAC. <br /> f' & ciy /Q. <br /> Owner/• . i e. Agent Signature <br /> Date (Rev' ed 3/2013) <br />