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1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHA VICALIPLUMBINGISIGN1 PRINKLERIDEMC LITION' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St,Everett,WA 98201 425-257-8810 FAX 425=257-8857 wvvw.everettvva.om <br /> SITE il es PROPERTY TAX tt ki W A7 . 1 �PERMIT0-1�01 ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 44 C D7ovAt1.1„ci, Phone/E-mail <br /> Addressrv fv,i,A yrGityiStateizip 7 T <br /> APPLICANT: Omer Owner's Agent Contractor , Contractor's Agent Tenant(must provide a i rot consent from the Owner t6 do work to the space) <br /> CONTRACTOR ciLyfr4 vc # Lws.A"► C State Lic.# 0.- City Bus.Lic.ft fe . .vet.+ Vic," <br /> Address ille."° / ' Phone/Emari 5+ft+ { ;z d <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> VAC.. } ....1),. Phone/E-mail le.$),-,..„3 , 0- ` -,: r,c d Ie ,„,yje c 4s„1- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 00/6 Oa <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas ElectricOther <br /> Building type: Single Family Duplex 'Townhouse Multi-Family. Commercial <br /> Type of project: New _Addition Remodel.,, ,Repair*Ti. ,Sign, _Sprinkler DemolitionChange of Use; <br /> DESCRIPTION OF WORK(additional space proitided on the back): <br /> MO t La. r , e$4 . d xs 01 t,,,,,•-.))- f � 1 ::' c F)-- <br /> MECHANICAL PERMIT APPLICATION P " .: TAAPPLICATION` <br /> Type of Project. New Addn Alteration fir Type of Project: _New: AddnAlteration_Repair <br /> Show Number(#)of fixtures Show Nurer(#)of fixtures <br /> A/C—air handling units i Toilet: <br /> Forced air systemsBathtub <br /> Gas piping Lavatory`(wash€eater) <br /> Water heater i Wirer <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas ranee I' Dishwasher <br /> Clothes dryer Clothes washer <br /> Ranke hood Water heater <br /> Exhaust fan t Sink(service/bar/rnop/etc:); <br /> Heat pump Backflow preventer <br /> Unit heater , Urinal <br /> t Boiler -.L king Fountain <br /> iRefrigeration I -Floor drain <br /> Woodstove 1 Grease trap <br /> ` Ducting Roof drains <br /> Other 1 Medical Gas <br /> SPRINKLER t STIP RESSIONSYSTEM. <br /> I Number of Heads _ i Other: <br /> i hereby certify that 1 have read and examined this application and know the sameto-be true and'cr rrect.All provisions of taws and ordinances governing thistype of work will be comp <br /> with whether spangled horoin or net•Trio,granting.of a permit dada riot procumo,to givaauthority to viotats or comet the prowhien of any eater ate or local law regulating_conetruotton. <br /> That i am authorized by the owner of this property to perform the.work for which application" made and 1 comply with the State Contractors Law 21327 RCW and 29&200A mA(1 <br /> •""" "� <br /> Owner/Authorized gent;signature Data (Revised 9/20/A) <br />