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gUkt4>t0 ` St <br /> PERMIT APPLICATION vtort-13-4 <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 /> .2-gosrQoo 1 o 3 L.17i3 <br /> SITE ADDRESS: Ili PROPERTY TAX# PE tl��I�� <br /> IDC,T PI SE: Lgo.�`/9nv/n.�Y•OP C14 _04,, <br /> Pt . VP scr• <br /> LEGAL for new construction: Short Plat/su division Lot No. (attach copy of long legal description) <br /> OWNER 4L,& GOAT' U..Co Phone/E-mail Le s he t IfIN a.,h e t.m.ei nt:rj d9C 690 r.COM <br /> Address 17 9ZI U ,L EV$ f twit SUtT' IIV City/State/Zip gp'-4 U- t W,4• ( (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 RS Ixb0lPe State Lic.# City Bus. Lic.# <br /> Address SCa 4+ . US COD OV 2. Phone/Email grlot ar Q 6 oije. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail .ate a r Dt.b Ove. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 1 8 7 6 8 2- <br /> Existing Use of R"tta°--- WA HEAT SOURCE: <br /> , <br /> Proposed Use yr minding_ A tT AC-445 \S / kt Gas Ne... 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 /> IESCRIPTION OF WORK(additional space provided on the back): <br /> MSI) -tcwN '4om vor 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 /> NC—air handling units ?j Toilet <br /> ( Forced air systems 1 Bathtub <br /> 2 Gas piping ?, Lavatory(wash basin) <br /> 1 Water heater Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range 1 Dishwasher <br /> 1 Clothes dryer i Clothes washer <br /> I Range hood '4' I er nester--- <br /> 4 Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump 1 Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting _ Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> ---� I Number of Heads I 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 <br /> Owner/Auth' Agent Signature Date d 3/2013) <br />