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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# P <br /> �l0y 56 ev&/i'Eir'r "1 t- 144411I7e) I9& 3a K!ao I Prib g -i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 114C.6 r Phone/E-mail <br /> Address City/State/Zip <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 81p/M$7o*E j%/RE $A,Fe7 Y State Lic.# //N5p$cj/9 It' ' City Bus.Lic.# 7609 <br /> Address 3 y 1V $7 I4 04 k4 *V4f 41/ IuIRI TtNIP�//115'to/Y P..or;f, ' <br /> ?. ,f� qs0� . Phone/ mail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Ti411 <br /> 4 Phone/E-ma •1417piP/.'197 'E Fr46 gA e7`f, Gam? <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK l�7/00 a s <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family IC i✓�ommercial om <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 /> fro%l, /otoo 6 5,0/P/4'stt y Tho i <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 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 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/SUPPRESSION SYSTEM Other: <br /> 2 I Number of Heads Other: <br /> l 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 comp <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 /> /L..,. /0/ 08 0 <br /> •wner!Aut i y.tr*r ignature Date (Revised 9/2014) <br />