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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:.2,2 1a1 " 09.c g PROPERTY TAX# _I P R T t <br /> 'np �.p� w� <br /> LEGAL for new construction: Short Plat/subdivision c L 't �, I l V1q/YS Lot No.l%SC3 (attach copy of long legal description) <br /> OWNERr9601,44S,POCt c, ymos Phone/E-mail 1425 ¶).5 2? (}t� '( <br /> Address L.(� SVS �_,d e j 1-+ (',l 4 \ i�,J- IDD City/State/Zip �e 'e I- t p. q 2S 11)4 <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 Arc ictl()Ced Our()r()bj y�tx tr3 'y, State Lic.# rn)V/ 1\f PLL 1 7L$itby Bus.Lic.# 2gi-�.X . <br /> •Address i 9-22, p-a �r.1 r �°, s�( e O SnoYIvyrt()1) wj- Phone/Email Lj`2)5 3-l2 5'co <br /> TENANT B ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 426 LI g 5 IOC) . <br /> BUILDING PERMIT APPLICATION`— CONTRACT PRICE OF WORK $�f i7.00 <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. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): Q r o O( `O(4 <br /> t � � _ 1 <br /> uSe 5uppi( J5s7c,r() <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 /> Refri•eration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> 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..:.The grantm`g oof amink does not-presumetorgive authority to violate or cancel the-provision-of-any-other state-or-local-law regulating construction---- ------- <br /> That I am authorized by the. - er of this prope 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 /> tx 2,2// <br /> Owner/Authorized Agent Signature / Date (Revised 9/2014) <br /> 6:61) <br />