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1 <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.ev,,,,,e,,,tttr"""ettwa.org <br /> SITE ADDRESS:,..,." IO Iq-rh 0?- SE PROPERTY TAX# CCt 'CO <br /> F q--LEGAL for new con==struction: Short Plat/subdivision i11Q\Y1t K AVItS Lot No.N 9 (attach copy of long legal ddescriription) <br /> OWNER Sec kQ Q 4. +“C H Om{_S Phone/E-mail z 25 ct.65 200 <br /> Address 1.20 v.) \iL,t -frat1vA iil OD City/State/Zip f=Jg(.244. q'2. <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 I,,?/t2d j91umbifk3 phi/4-6/19 State Lic.# a�p ig pi,917�,5 City Bus.Lic.# osz 4 g <br /> ` <br /> Phone/Email 11.2 3 y g (J 1 O� <br /> Address A c72,2, �jfG�:tf/�)�',� ,5Glf>�E�: S{!jC9fr1(St°Y)35t%'J.inf7l� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT . <br /> Phone/E-mail 26 542 W 510® <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 <br /> Type of project: New _Addition Remodel Repair T.I._Sic,�n Sprinkler Demolition Change of Use p <br /> DESCRIPTION OF WORK(additional space provided on the back): Ot( ,OCO Citi <br /> MU i—11 — (..jt56 f I ILL 5 a f9, ' / -' `.&fl" I e <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 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 /> 2i I 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 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 bythe <br /> wnwner 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 /> G���!� �� , ‘./kiri /2/47/76 <br /> Owner/Authorized Agent S gn. ure Date -- Revised 9/2014) <br /> ff <br />