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%' 'RMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBUNG/SIGN/SPRINKLERIDEfMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX iI T PERMIT# <br /> i~ <br /> LEGAL for neva construction: Short Plat/subdivision f• er f r t testi 71-- Lot No. ,S (attach copy of long legal description) <br /> OWNER 5ec'. PG,G. 140/11-E 3 Phone/E-maily00-�fj,�-o' Li / JCW1t5,CO <br /> Address!aQ 5\4/ E teem sl1 Lt5.R'j G�r �� iYO City/State/Zip EL cv c•71--{ Lrj.. 9 D01-/ <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 /> CONTRACTOR3cc Dctt State Lic.# a ATT-pj-100513u City Bus. Lic.`1003-,)lo/v".3 -0 <br /> Address( O 5tA, Elk, ri ?{ c e„,✓ w 61%, -1)1 Phone/E./far-15-3"-)sSeC/ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Fwulr� bc�. �4 <br /> fl ct aost�^�LJ- <br /> Phone/E-mail )5j^-3l S-)i30/0'0+,t�Lt�e',. rLt0l 1e . h ) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas X 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 /> (3G5 R131ScI — O° X <br /> MECHANICAL PERMIT APPLICA ➢ON PLUMBING PERMIT APPL1C,..: ?'S <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 { Toilet <br /> / Forced air systems I Bathtub <br /> 3 j Gas piping Lavatory(wash basin) <br /> j Water heater / Shower <br /> 1 Gas fireplace / I Kitchen sink&disposal <br /> 1 i Gas range / { Dishwasher <br /> Clothes dryer / j Clothes washer <br /> 1 I Range hood <br /> j Exhaust fan f Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater 1 Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESE-ii a % ',YEEOther. <br /> Number of Heads I Other: <br /> I hereby 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 stale 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 298.200A WAC. <br /> i ,,e <br /> Owner/Authorized Agent Signature Date ��� (Revised 3/2013) <br />