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• <br /> • <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLIT1ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St.. Everett,WA 98201 425-257-8810 FAX 425-257-8857 www•everettwa.org <br /> 11MMSITE ADDRE S: PR TAX�r cm 9 00 <br /> `IS5ct A1vmL D Io <br /> LEGAL for new construction: Short Platlsubdtvision _ <br /> M <br /> Lot No. (attach copy of long legal description) <br /> OWNER or RO-.1(1 Phone/E-mail (40.5 . 5 .-Ir. <br /> Olty/statelZip <br /> Address +._4— <br /> APPLICANT:_Owner __ <br /> CONTRACTOR �.f�IJ'�t'L..�M ��e L.Owner's Agent —Contractor _contractor's Agent Tenant(must provide a leiter of consent tram the owner to do works In� e space) <br /> State Llc.# IG City Bus. Lic.#0of p 0 <br /> (�. t <br /> £ Phone/Email , ► 'pi 4"I 4a 't `Q'b <br /> Address 0ki‘ _ <br /> CONTACT FOR PERMIT Q.1 t 1 L o "�' 1 <br /> TENANT BUSINESS NAME � <br /> Phone/E-mall $0,1rt%. -4--60 P A 4A .m. • ' ��ti &.: <br /> BUILDING PERMIT APPLICATION <br /> CONTRACT PRICE OF WORK �' - <br /> Existing Use of Building HEAT SOURCE: <br /> - <br /> Gas Electric Other <br /> Proposed Use of Building <br /> Building type: Single Family Duplex Townhouse _.M ti-Family Commercial Change of Use <br /> Type of protect: New Addition Remodel Re air T.I. Sign Sprinkler Demolition S <br /> DESCRIPTION OF WORK(additional ce provided on the back): <br /> c C &- Ra f Y\,04, ' •-, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project New Addn _Alteration,f'Repair Type of Project New Adds 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 Showery wash basin <br /> Water heater <br /> Gas fireplace Kitchen sink&dirt.osal <br /> Dishwasher _ <br /> Gas rdyer — Clothes washer _. <br /> Clothes hood ( Water heater <br /> Ran ue ooSink service/berlm4 etc. <br /> Exhaust fan Backflow .reventer <br /> Heat pump. UrinalBolt heater Drinkin• Fountain <br /> Boller <br /> Floor drain <br /> Refrigeration Grseeatra <br /> W ve Roof drains <br /> �- <br /> Ducctingling <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certify that I have read and examined this application and knew the some to be true and correct.All provisions of lawn and ordinance-governing this type of work will be camp <br /> 1 whether specified herein or not.The granting or a permit docs not presume to give authority to violate or cermet the provision of any other stale or local law regulating construction <br /> I am authorized by the own r of this properyto perform the work for w Ich eppll lion in made and I comply with the Stole Contreotofs Lew 10.27 ROW and 296.200A WAG. <br /> -,. A A A k A s>l � ' S (Revised 912014) <br /> 0- ,rlAuthor ed Agent Signature ate <br />