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• • <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> ...... <br /> Z,O t l3 _cMbr-ra Ave /� OO /39i(0O goQcoo <br /> LEGAL for new constructtt1ion: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Jeza.n\i.F•litivlA.YiA Phone/E-mail 9LS-3171;32 je+v,rittenanr.(oEF*atier.cwh <br /> Address 2-o 1(;, 'Li r o a\ 1„A1 Ave . City/State/Zip E V tP mot{. ,uA)/} 9 I' 1-Ci <br /> CONTRACTOR ll v n€ (r)6,0n -"-- L& I Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building i(le,rI cI'Np hot;:,(. HEAT SOURCE: <br /> Proposed Use of Building I t.961 I— f vn,i 1 S/n16e.6 F44 LLq 465. Gas_ Electric_ Other_ <br /> Building type: X Single Family _Duplex_Townhouse . Nip n gamily Commercial <br /> Type of project: _New _Addition V Remodel _Repair T.I. Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on the back): <br /> y SSA <br /> Have you started working without a permit? YES 'V NO <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 l Dishwasher <br /> I Clothes dryer f Clothes washer <br /> Range hood Water heater <br /> f 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 /> 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 <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> -.------- -- ---I-'"' "--'''---- --' <br /> 4 1/6/Z-0 I l <br /> Owner/Authorized Agent Signature Date (Revised 2/2011) <br />