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t1110 <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:09�S� e/j'�47 'PROPERTY TAX# t i &`� <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> OWNER 7'M.' ..'m `'`Hoj J/co Mgr Tat,FAPhone/E-mail <br /> Address a0io is SC ti ,-VE/i(f(.ri St 4,00 City/State/Zip /,/G I e.--l.J % o7 <br /> APPLICANT:_Owner _Owner's Agent MContractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR eCA44'11€A.� f ,'A- qL&I Lic.#E��L.i'eQD'V� COE Bus.Lic.# <br /> Address 3�(b i3. s1-- 4.742vs �/#1t ri-y/f-00/ Phone/Email )04-2- 09 L(D <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ac -t v <br /> Q /JSW3 Phone/E-mail 4/44pg <br /> cot <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 5110,C) <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. Si n_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on t e back): r.0 4" t 11 vv�r p�.''4 Qur'Urt(.- <br /> �w'e (.6^"i u -rro Au. Mec,L-1 €4-7 .e,�` �t.— /"�c,�t k-fow, 5/is'r:L . <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 /> 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 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 r a• •-•-examined this a• :tion 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 specifi/-•'' or not.The gran' •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:uth• . • i e own-. . this•;arty 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 /> -g°71 <br /> • n uthorized Agent Signature Date (Revised 6/2012) <br />