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• <br /> PERMIT APPLICATION 13W17" g-; <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 /> 28P5Igjpo/193zcv <br /> SITE ADDRESS 1 2. Q d_GTII pi 5.E PROZT <br /> kOrl 9 PO/C7 Y.Ot' P O LE 09—®� <br /> I <br /> Pte� '°ifN ` � w• <br /> LEGAL for new construction: Short Plat/sulidlvislon � Lot No. (attach copy of long legal description) <br /> OWNER atIP-110-ILM Gt7VRT LLC Phone/E-mail Le S hel v1kAM a PUtt rte Lo*wps•tont <br /> Address {7 LI ZI t,O11 U.-E/ U41 t41,V1f. S IT's {1y City/State/Zip gV Eu- r Qod t Z <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 511441'4- olyS cub Q State Lic.# City Bus. Lic.# <br /> Address scout as R.13002. Phone/Email ScwN't elf a 6 0VE <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S-AnnAt,a r Oc,b rive. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 % Z, 5 R o <br /> Existing Use of Ri,i- N/A HEAT SOURCE: <br /> ` <br /> Proposed Use ur oullding_ A'WA -11,1m..410/69 Gas ✓ Electric Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> -hype 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 wIJ WM, VIJI r -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 /> NC-air handling units �? Toilet <br /> Forced air systems Z, ( Bathtub <br /> Gas piping 3 I Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> { Clothes dryer { i Clothes washer <br /> Range hood <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump { 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 I SUPPRESSION SYSTEM Other: <br /> 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 296.21•• 4 •C. <br /> Zvi y <br /> Owner/Auth.4117 Agent Signature Date (Revised 3/2013) <br />