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PE.RMiTAPPLICAT1011 <br /> BUIL.DING/MEC HANICAL/PLUMBING/SIGN/SPRINKL.ER/DEIV OUTI®N <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: VRopFRTvTAx# P5RMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LA(Z De-PLATA VILLA L.Z.C. Phone/E-mail <7, �y,Q,f�aRe�i�t.,s7�r�E.CAy <br /> Address 6a0 IIalksT SZ'. OFFIGV City/State/Zip 4411-wrrlL44 <br /> APPLICANT: Owner Owner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> C C o46 C16- <br /> CONTRACTOR CAR NCC CON&TPI CTION State Lic.#(:.*W ,Q L City Bus. Lic.#05 7g& <br /> c,264 0601 <br /> Address 110,50 3)61ALe giv- SZATTI� LVA .9F44 P o yll G.MfAe- <br /> RR/tAKp GN1.4/A•C <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Gz=oRra= o2C6 4i01 o6a <br /> Phone/E-mail CkCAR A CZ)eGMAILj nn <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r C06- <br /> Existing Use of Building / HEAT SOURCE; , <br /> Proposed Use of Building 6j0qRA6t' 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 /> 04;1.0,4 F•QE�-sTSl.oii�G G/ f+cat ivt�tr oo M��vFRC7 A4W oOt3oW&; <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 Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pumpBackflow preventer(inside bldg) <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 /> Number of Heads 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 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 /> Revised 4/2015) <br /> Q"rmy/Autho ed Agent Signature Date <br /> Z <br />