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likERMIT APPLICATI <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# P RMIT# <br /> t 1 n-5© -ice �Jr �0 --,.�r�- l 5 Cho - 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> OWNER tadooD6azov, Q Agsuc- I.A. - Phone/E-mail <br /> Address it 010 1121...t' City/State/Zip l^/ t p„ . E <br /> APPLICANT:_Owner _Owner's Agent Ck Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR 1:::e-t4 2..ezroczAnoN State Lic.#0003•^1-1 T -3% City Bus. Lic.#QSo <br /> I (QmAddress1 + Q1, "Trt 1"A. Phone/ ai <br /> l . I -t- 24 raj/M <br /> NANT BUESSNAME CONTACT FOR PERMIT <br /> kiJ'dJV $4- AsDk{- CI4'iC QQ�� t <br /> P© -mal <br /> • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK `j f 00 0 <br /> Existing Use of Building Pt Pse—ts-( c HEAT SOURCE: <br /> Proposed Use of Building 3 i.( � Gas_ Electric Other <br /> Building type: Single Family Duplex Townhouse A Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel x 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: 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) <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 a - • z:.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 298.200A WAC. <br /> % b <br /> 0 e •ri gen Signatur a (Revised 4/2015) <br /> • <br /> L <br /> • <br />