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ERMIT 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# PER IT# <br /> L 3 Ltl's-t Mild 1 L10 61vcd oo/, 1-1°00 Zoo() 2_- f 50 4 - 003 <br /> ,, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of!Ong legal description) <br /> OWNER -?0,-k-i 1.C�L TL48�I(1 Phone/E-mail <br /> Address (OLtr VA ski:A�hm T Sw City/State/Zip 11/k(Mal 1-Ge wA DIR,Z1 S` <br /> APPLICANT: Owner Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to da work In the space) <br /> C RAC 64.14-4 State Lic.# City Bus. Lic.# ` _____, <br /> Addrees Ott <br /> TERANTBINIFIEMIAWIE CONTACT FOR PERMIT --F rrcs 63,4%- amu.LLQ <br /> Phone/E-mail 2.-0G- '51 I- g 3 ff co • 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 41(11._ c• i' a. - & S _ HEAT SOURCE: <br /> • <br /> Proposed Use of Building (v (PcGasc_ ElectriOther_ <br /> Building type: X Single Family _Duplex_Townhouse —Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler x Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional kLO1S€ <br /> space provided on the back): <br /> Perio ( a7D <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) 1 <br /> Water heater Shower <br /> . I 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(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 /> Lt P-) IIS <br /> erIAuthorized Agent Signature Date (Revised 4/2015) <br /> J/2, <br />