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� p�����a���a����� <br />���������������u���f�����i��r�i��r���������i�����,����� <br />�� C1iY OF EVEREiT P�}�il�1T SERV1�lE� <br />3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.e�erettwa.Qrg <br />51TE ADDRESS: PROPERTYTAX # ERM T# <br />' ��� I� <br />���� Ck-v �;1,� °i�e, �✓<<- <br />L�GAI. for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal descriptiDn) <br />� � ��� / �'J�� � /��C <br />OWNER ��� ,,� y �,� �� �^ Phone/E-mail <br />Address �'�g ,,ti� <br />APPLICANT: \ Owner _, Owner's Agent �, Contractor <br />CONTRACTOR � �- S /� �"(Z(= r r1 y �C^� �'� <br />.—, . ,-� ,. " � <br />� r � r�'al U., <br />Cont�aclor's Ageilt _ Te�ant (musl provida a Is4er of consent froin 1he owner fo dp work In ihe space) <br />- �z f <br />� State Lic, # C 't S�� �/�'`1 Clty Bus, �.ic. # 2 Gj <br />��`,� ��v� 3 Phone/Email �� j'— �� � %� O�p,�� <br />� . -�, ���c� <br />/l-` � � �.`Y,�o � � G •� Phone/Email � -� 2 � �. — <br />`�U ,S u:, �C b � `� �� <br />BUI�.DING PERMIT AFPLICATIO�i coNT�cT PR1cE oF woRK <br />• HFAT SOURCE: <br />Existing Use of Bullding • <br />Froposed Use �f Bulldlflg Gas_ Electric �Dther <br />Building type: � Single Family _ Duplex _Townhouse _ Muiti-Family � Commercial <br />Type of project: _ New ,_ Addition _ Remodel _ Repai� _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on fhe back) : <br />� ��� � c-� � � <br />MECHANICAL PERMIT APPLICAT <br />ofProje�t: _New_Addn ,_Alteration,_.Repair <br />Show Numker (#) of fixfures <br />A/C - air handiing units <br />Forced air systems <br />Gas pipirig <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />" Exhaust fan <br />Heat pump <br />� Unit heater _ <br />of Project: ^New _Addn _._,Alteration _.Repair <br />Sho�v Number (#) of fixtures <br />� Toilet <br />Shower <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer � <br />Water heater <br />Siok (service/badmop/etc,, <br />Backflow preventef (inside <br />Urinal � <br />Drin►�ina Fountain <br />► Ducting J Koor drams . <br />I Other Medical Gas <br />SPRIRII���R J �U�'P���S➢�6�9 ����'��i1 other; .. <br />Number of Heads Other: . _ <br />I hereby cettify that I have read and examined ihis appllcation and know ihe same to be irue and correct AU provisions of laws and ordinances governing ihis lype of work will be comp��ed <br />with whether specified herein o� not. The graniin9 of a pe�mit does noi presume to give authority {o violate or cance�ihe p�oVision of any other staie or local law regulating construclio� <br />T t I am authorized by the owner of this property to perform the wark for which application is made and � comply with the State Coniractors Law 1 �.27 RCW a��6.2DoA WAC. <br />%� t�-�2 C A i7 a � u�l�'� (� L� (� �� � i� <br />r7;1 SJ (Revlsed 4/2095) <br />WnerlAuthorized Agent Signature Date <br />