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MAY/02/2016/MON 11 : 52 AM North Creek hoofing FAX No, 425 T 524 P, 002/002 <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 425-2578857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTYTAX# <br /> PMT <br /> 42 <br /> LEGAL for new construction; Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phorte/E-mai C, — � <br /> Address City/State/Zip 6V ffuy Q-� <br /> APPLICANT:_Owner _Owner'S Agent A Contractor —Contractors Agent _Tenant(must pmvida a letter of consertrmin the ownerto do work in the space) <br /> CONTRACTOR t('4tWA kk- O ( L I RIC.# COE Bus. Lip,#632�°t <br /> Address d�� It C�QlIv 1�+(i rel y Q'�blZ Phone/Email Lo <br /> TENANT BUSINESS NAME QONTACT FOR PERMIT <br /> Phone/E-m + <br /> ail `-'lZS` u -3- Ick-t- <br /> BUILIDING 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-1 amity —commercial <br /> Type of project _New _Addition Remodel Repair T.1, Sin Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the baM: Q <br /> MECHANICAL PI=RMIT APPLICATION PLUM13INIG 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 airs stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&die osal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink setvice/bar/rno /etc. <br /> Heat pump Backflow preventer <br /> Unit heater <br /> B . � Urinal <br /> oiler <br /> Drinkin Fountain <br /> Refrigeration f Floor drain <br /> Woodstove Grease trap <br /> Ducting hoof drains <br /> Other Medical Gas <br /> SPRINKLER I 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 end ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit doss not presume to give authority to violate or cancel the provision or any other state ortocal law regulating construction <br /> Tnel I am authorized by the owner of this property to Perform the work forwhich application is made and I comply with the Slate Contractors taw 18.27 RCW and 298.200A WAC. <br /> dLt,t i 17 A&J'ZJ'4,� 6s- /'ZO I � <br /> 0 er/Authorized Agent SWrkturGr V Date <br /> (Revised 6/2012) <br />