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r <br /> 05/28/2014 11:00 3606580124 HAMBLEN & SONS PAGE 01/01 <br /> 4Lin !r L ' 9 D/ - 0/23 <br /> � Y <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 /> SITE ADDRESS: PROPERTY TAX# Pli:�M"IT# <br /> _ f6Qisr (2)TB <br /> T SE L /i/1 lot-1 ✓vt lc; -0c4 <br /> LEGAL for new constructioln-'Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> OWNER: Y I -k .l4-'j /�/1 % Phone/E-mail 425 478•t/Z/7 <br /> Address I 60n I'`�t�r�,,, ((((�'T sr `Jf� �. , 02, City/State/Zip Cje,ye <br /> APPLICANT: Owner Owners Agent ContractorContractor's Agent Tenant(rnustprovideatetterofconsentnomtheownertodoworkIntirespace) <br /> CONTRACT/OR LcAl S . state Lic.#tm � <br /> Ai �1-1 tj pc City Bus, Lic.#M0lp 36, <br /> Adcliess 1Tt� lAf0 Q /i Ali,. / t �1)�/ t/ Phone/Email 475 • 5e,/ - 01,23 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> '�. I <br /> I • Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ ,,41Dz). da <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other_ <br /> Building type: Single Family _Duplex Townhouse _.Multi-Family Commercial 2 Ger)lp, <br /> Type of project:__New Addition _Remodel (52Pepair_T.I. Sign_Sprinkler Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space providedon the back): <br /> l-b4 90 44e, - .. .- Z4v�/. 1u44 -: <br /> /� eir,Y-.,W/� mei.ta. $AeG..e xi4 `/se <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Add') Alteration,XRepalr Type of Project: New_Atkin Alteration Repair <br /> Show Number(a)of fixtures Show Number(#)of fixtures <br /> 1 AIC-sir handling units J TOilet <br /> Forced air systems _ r Bathtub <br /> 3 Gas piping Lavatory(wash basin) <br /> Water heater -T Shower <br /> Gas fireplace ! Kitchen sink&disposal <br /> I Gas range _ Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan _ Sink(service/bar/mo p/etc,) . <br /> Heat pump ! Backflow preventer <br /> Unit heater Urinal <br /> Boiler - <br /> ! _Drinking Fountain <br /> Refrigeration _ j Floor drain . <br /> i Woodstove ! Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM t <br /> Other: <br /> r Number of Heads <br /> 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 state or local law regulating construction • <br /> That I am authorized by the owner of thio property to perform the work for which application is made end I comply with the State Contractors Law 1927 ROW and 290.200A WAC. 1 <br /> „ ./1:":„../ fir, fe141 ' <br /> O nerlAuthorizod Agent Signature Date (Revised 3/2013) <br />