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MAY/10/2016/TUE 11 : 34 AM Norii Creek Roofing FAX No, 425 487 6524 P, 002 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> MY 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: PROPERTY7AX# P MIT# _I 2.I <br /> LEGAL for new construction: Short Plat/aubdivision Lot IJo. (a—tach copy of tong legal description) <br /> OWNERO�S j Phone/E-mail (�J q "`�L� <br /> Address z`` "IV Citylstate/zip --v�Lr^— <br /> APPLICANT:_Owner _Owner s A t ,Contractor `Contractors Agent _Tenant(rot,t provide a tad.rof conmnt from the owner to do wore in the space) <br /> CONTRACTOR (, 1Vl C. L&I U0,# COE Bus.Lic.#',63250t <br /> Address O K&CvxtC V T1 V C(r , Phone/Email 2 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phcna/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ° <br /> Existing Use of Building HEATSOURCE: <br /> Proposed Use1�ingle <br /> lding GasElectricother_ <br /> Building type: Family —Duplex_Townhouse —Multi-Family —Commercial <br /> T e of ro[ect: New Addition Remodel _Repair T.J. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(edditionel space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteratlon`Rspalr Type of Project: _New_Addn _Alteration_Repatr <br /> Show Number(#)of fixtures Show Numbs,Mof fixtures <br /> A/C^air handling units Toilet <br /> Forced airs sterns Bathtub <br /> Gas piping Lavatol 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 <br /> Drinking Fountain <br /> Refrigeration or drain <br /> n Woodstove Grease Era <br /> Duct[nq Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certiry that I have read and examined this application and know the same to be true and correct.All provisions ortaws and ordinances governing this type of work will be complied <br /> with whether speclhed herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision or any other state orloc2l law regulaiing W-0ruction <br /> That I am authorized by the owner of this property to perform the work for which application is made end I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> Cc's � 6 <br /> Wnsr ut orized A e ature Data (Revised 6/2012) <br />