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Nov, 4. 2015 1 : 36PM No, 0761 P. 2 <br /> 0 • <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 /> SITE ADDRESS: `i PROPERTY TAX ft PIERMIT# <br /> y 1151 1't IL <br /> LEGAL for new construction: SIwrL Plat/subdlvlslon, Lot Nu. (atl3cll copy of long legal description) <br /> OWNER t <br /> ��(Lv G E i(,�..t' C.C��:_..f �.� Pllono/L-11331E Y�l L�� �. 'C-h � r,ac,,y- Z (..• <br /> Address U�jh ') ) �.) _. C_ city/slatefzlp ,; c'. 2' "tc' <br /> APPLICANT:. Owner _Owner's Agent _Contractor Contmotor's Agent _Tenant(mum piovido a luiler of cofiwnt ffum u16 omer to do woflon m-spar.n) <br /> CONTRACTOR 1"7� :�, .t fL...��� <.Z State Lic.# (.9�, �... r t:.: ",�'%1�. Clfy Bus, Lt0, <br /> Addruss J Ea'. :-%V l.'�.4: -. t.L .::ai ::l_c: rI,16% f honelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/L-mail <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK n r <br /> Existing Use of building Wµ HEAL'SOURCE: <br /> Proposod Use of Building GaR Electric Other <br /> Building type: _Single Family _Duplex_Townhouse ulti-Famil _Commercial <br /> Type of project: New Addition Remodel Ro air T.L Sin Sprinkler Demolition Chan c of Use <br /> DESCRIPTION OF WORK(addilional space provided On the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typc of Project' _New_Addn A Alteration,__-Rcpair Type of Project: _New_Adds , ._Alteratlon_Repair <br /> Show Number # of fixfuros Show Ndi1)b0r N o/flxrures <br /> A/C—air handlin unit Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavator wash basin <br /> Wator hoater Shower <br /> Gas firotaco Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes df ar Clothes washer <br /> Ranqe hood Wator heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow provonter <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Cas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I Itefeby eerllty that I have road and exarniiied lids applicatlon end know tho aamc to be trot:and ronrrl.All provisions or laws and ordlnencea govominn this typo of work will ue compl <br /> with whether spodficd Immin of nut.The granilne or a permit does not prosurim to givr.milhudly lu violate or cancel the provision of any othcr stair;nr lnraf hw ir.Uulaling consiructton <br /> .'hat 1 am ayi;rofized uy the owner of this property to perform the wwk fur'wtriclf sppllcauon Is made end I comply with iho Stair ConharaurA.I.aw 10.27 RCW and 290.2UOA WAG. <br /> O TAuthorized Agont Signature Vale (Revised 912014) <br />