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11 <br /> 9ERMIT APPLICATIO <br /> BUILDING/MECHANICAL/PLUMBING/SIG N/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# PERMIT# <br /> 1 J 5k) FVF—Q�tI IkAA-L1- t„�(�� CSU`.f LF f3 2-&t(0/L(6o � T1 <br /> LEGAL for new construction: Short Plat/subdivision l"i A Lot No. (attach copy of long legal description) <br /> OWNER L, k fAV, A-4,3 a/,qj E6 Phone/E-mail SUc^213- 3 3 9 i <br /> Address PQ t)ox, .�C>C9 3 131-LLLVVE City/State/Zip k/A 9900(? <br /> APPLICANT:—Owner _Owner's Agent X Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work In the <br /> space) <br /> CONTRACTOR rgd�l/A,QC- S 11,WS LLC State Lic.# r4(�V4AJSL-.1C�0P City Bus. Lic.# 3'16 <br /> _ SL-`Awi-c'12.JC.,&N4AI L•e-C, <br /> Address I ?? r k 5T- A/ti f 0 C- R✓t3✓�hl, i,/,1 q21,)1)I Phone/Email 253-111$i 5-OW 7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail Z t;-,3 -C87- 54()C( g5�•if}y�LvR.�(�6u�4/�. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 5,oocl,-�/J <br /> Existing Use of Building Cv!t/2iE dCl AL HEAT SOURCE: <br /> Proposed Use of Building –1JM-"?c a C►A L t Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type ofproject: New Addition Remodel Re air T.I. X Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 7" 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&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 inside bld <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refricieration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other 1 G 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 this type of work will be comp <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 o ro`pp rty 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 /> / P ��r3// -) '17, <br /> O erlAuthorized Agent Signature Date (Revised 4/2015) <br />