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04/O7!2015 13:01 BEL RED ENERGY SOLUTIONS (FAX)4254935354 P.0011002 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8890 FAX 425-257-8857 www.averettwa.org <br /> SITE A�11]RESS;r, PROPERTY TAX# PERMIT# u <br /> C� 9 <br /> LEGAL for new construction: Short Plat/subdivision � _ Lot No, (attach copy of long legal description) <br /> OWNER Phone/E-mall <br /> Addrees �� City/Statelzip C\Je_C(24 <br /> APPLICANT:—Owner —Owner'aAgenf Contractor Contractor's Agent _Tenant(must provid.al.curofwnsanttrommeovwtodovor%InMeapace) <br /> CONTRACTOR - < j )i Slate Llo.# 1 city Sus. Lic.# agg <br /> Address �� ��, (� A � Phone/Emai ��� <br /> TENANT SUSINESS NAME tolooj CONTACT FOR PERN4!-T <br /> (Y1te�21le K UQ-� <br /> PttonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building_ HEAT SOURCE: <br /> Proposed Use of Building _ QaaX Electrlc Other <br /> Building type: �Single Family _ Duplex`Tovvnho se _Multl-Famlly _Commercial ' <br /> Type of ro®ct: New _Addition _Remodel Repair T.I. Sign—Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(addlllonal space pmvtdad on the back)' <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Projact: _—New WAddn —Alteration XRepnlr ry flI Typa of Project: _Naw_Addn _Alteration`Repair <br /> SlrowlVumber # aftlxfures r '1' ShowNumbsr fR of fixtures <br /> PJC–air handlino units Tollat <br /> Forced airs stems bathtub <br /> Gas piping Lavato wash basin <br /> Water heater Shc)war <br /> Gas fireplace Kitchen slnk&disposal <br /> Gas rangla Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat pump Backflow praventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refrigeration Floor draln <br /> Woodstove Grease trap <br /> DuctInq Roof dralns <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other; <br /> Number of Heads Other: <br /> I hereby cehlty that I have road and examined thle applicallon and know the same to IN true and correct.All provlslons of laws and ordinances governing this type of work win to Comp <br /> with whether specified heroin or not.The gnnli f a permit does not presume to give authority to vlolate or cancel the provision of any other sleta or local law ragulating construction <br /> That V,am authorized by the owner of thlg pro tf to poAo 1116 Wor for which appllcatlon Is made and I comply with the State Contractors Lew 18.27 RCW and 296,200A WAC, <br /> Ow r/ uthorixed Agent Signature Date (Revlsed 912014) <br />