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I2 'T C -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 /> 28vsigoo I 3 e.vo <br /> SITE ADDRESS: \ PROPERTY TAX# P RM T# <br /> 14( <br /> —C1-02--- <br /> LEGAL for new construction: Short Plat/suodlvis o 2 Lot No. (attach copy of long legal description) <br /> OWNER f &RTI.414 C COt/ T LLC. Phone/E-mail Le S het tn1/4p4 ft riC Gam <br /> Address 17 etZ1 jq ,6%.L' EvVezT I4LQY. suag 1127 City/State/Zip gor4 5u,_ U.h4. Red t 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 5-134444, CI CIbov- State Lic.# City Bus. Lic.# <br /> Address $QMH as t bOV 2. Phone/Email Sam <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S-AA/4'e-ar Ot, Ove. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I 52, 5-R17 . <br /> Existing Use of R,at.r.--- HEAT SOURCE: <br /> Proposed Use ur rsuuding_•AkTrA C4 'I iN Gas ✓ Electric Other <br /> Building type: ✓Single Family —Duplex ✓,Townhouse ✓Multi-Family _Commercial <br /> —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 /> t\ISIO 1t7N 10VIT1r C-3 <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 �j Toilet <br /> Forced air systems !r/ Bathtub <br /> Z Gas piping j Lavatory(wash basin) <br /> ( Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer I i Clothes washer <br /> Range hood <br /> +-1 Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump ) ( Backflow preventer <br /> Unit heater Urinal <br /> Boiler i 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 /> f•L�•Zorn{ <br /> Owner/Au on -• Agent Signature Date (Revised 3/2013) <br />