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PERMIT APPLICATION' <br /> BUILDING/MECHANICA L/PLUMBING/SIGN/SPRIN KLER/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# PERM # <br /> BOO 3Q C ^as!!Q d 2%' 15T')o t o p sty, ©(o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER O, Phone/E-mail <br /> Address A0. alOx 3 707 A/$ 0"- --13 City/State/Zip Sea,LtIe- # (,VA q 8'I 2-Lt- ?-Ld7 <br /> APPLICANT:-KOwner _Owner's Agent —Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR MCFn 'G State Lic.# hQ:F ((- 4 A1C, City Bus.Lic.# d <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 1 Dave.Ttbler : 112-5-2-V-}q <br /> Phone/E-mail dek v i' �• Vb)er 0,6o&x-CO m <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <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 /> 18 1J. q 5 - 115 /2,r x ZS " Re.1roorrt <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 Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump ( Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration.___------ .__._-- -__-__- - <br /> ___._--.- .____-- _ ---_---_,---_Floor- drain-- <br /> Woodstove - <br /> Grease trap <br /> Ducting Roof drains <br /> Other ( Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby ceMP/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 /> z/ <br /> a <br /> Owner/Autho ize Ag t Signature Date (Revised 3/2013) <br />