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8191L4 Jt, 1P <br /> PERMIT APPLICATION G- C-4 <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 /> 2Sosfgooiv3zPi, <br /> SITE ADDRESS: - PROPERTY TAX# P IT# <br /> - 0Z. I V PI SE Lgo.-/9 O/n3Y-017 ( • ' -® T <br /> I-�, 0 PF --cr Wf <br /> LEGAL for new construction: Short Plat/su6division 2g(J 1=( a Ni. Lot No. (attach copy of long legal/description) <br /> OWNER 1�1 1t4tra GO �G Phone/E-mail tetI elwa.w . paL'i'!'�crjddekomex.Gam <br /> Address 17 4 Zi (S0 61.1-Ewan-t.&IT (4I.4)Y. sun.S IIx,City/State/Zip gm-14 ELI._ t 1,(x,4. (leo 12 <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 c;5 %Uwe, State Lic.# City Bus. Lic.# <br /> Address Sam as al)Dm. Phone/Email SfL4i Qt above. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail SAS a a,bovp. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I zz 6'1 C7?-± <br /> Existing Use of R"tt — IVA HEAT SOURCE: <br /> , <br /> Proposed Use or building_ 4tj'AG 'I/ INVOMS Gas f Electric Other_ <br /> Building type: ✓Single Family —Duplex ✓Townhouse VMulti-Family Commercial <br /> ,---Type of project: ✓New T Addition _Remodel Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> .ESCRIPTION OF WORK(additional space provided on the back): <br /> N -tcun '1101. vo r G.-4 <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 1- Toilet <br /> I Forced air systems . I Bathtub <br /> 2. Gas piping 5' I Lavatory(wash basin) • <br /> ______.I Water heater - I Shower <br /> Gas fireplace t Kitchen sink&disposal <br /> Gas range 1 Dishwasher <br /> I Clothes dryer I i Clothes washer <br /> I Range hood <br /> 5 Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump 1 Backflow preventer <br /> Unit heater Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> 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 296.200A WAC. <br /> 4b . <br /> Owner/Au z-d Agent Signature Date (Revised 3/2013) <br />