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1 <br /> i ERMIT ICATIOIJI <br /> BUILDING/MECHANICAL/ICJMBING IGN/SPRINKLER/DEMOLITION <br /> CITY O RMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: `� PROPERTY TAX# # <br /> ( , Zoc _fe,1 4 -UK\1- pr4IT <br /> 09-005 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of!Ong legal description) <br /> (OWNER - ?y 112-4-,e-Gt. Phone/E-mail (J- 5) 7 GO -'0ZF-d . <br /> Address t e 1(0 qy OC/ •c j 11, City/State/Zip _G\jsverr uj o , ZQ <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 /> C9ONTRACTOR 44.A ze::t c . ,, iSeAoj State Lic.# 11-VMz.12.i, 541 .1- City Bus. Lie.# c3-35-4rj • <br /> Address e L4+Ll1K .bfir , ` boa, c2Of Phone/Email (.4.2-5)(.4.2-5) 24"1^ 5t59 <br /> tNAN I IbUSINtSS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> • <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): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: Qi___•Addn icATteratiorRepair <br /> Show Number(#)of fixtures Show Number(#)of fixtu?es <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 1., 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 1 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 wilt 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 b iiiiner 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 /> th r d A.=nt •ignature Date (Revised 4/2015) <br />