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IPERMIT 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 ADDRES PROPERTY TAX# P IT# <br /> Il J7 Biwcw�.w 1 ,50Z- oo, <br /> LEGAL for new construction: Short Plat/subdivisio Lot No. (attach copy of Ibng legal description) <br /> OWNER K,c,Uj{) / iP n e M Vl)van,�/ Phone/E-mail <br /> Address ( 17 St -r-,k RA kr <br /> \,0 IALS h jet s City/State/Zip <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR t'V OOCt ilik a In Cc n s t r ch L)i State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TEVARTMIISTREST-Fmr <br /> �I� CONTACT FOR PERMIT <br /> 3I e4Nk'i� r/Y `t n-e- Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building ROCit c\-ref HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family Duplex Townhouse _Multi-Family V/ Commercial r <br /> Type of project: _New Addition _Remodel Repair T.I. Sign Sprinkler JDemolitionChange of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Do w il Oh 173 I WO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _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 j Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin)-., <br /> Water heater 7 ! Shower <br /> Gas fireplace-' Kitchen sink-&disposal <br /> Gas range" Dishwasher <br /> Clopfss dryer _I-tithes washer <br /> r4nge hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Zj Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration ,/ Floor drain <br /> Woodstove ! Grease trap <br /> Ducting ? Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> I 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 complied <br /> with whwt r Specified herein or not.Tie 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 Ilam aut brized byhe owner h'prop 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 /> I 4- / <br /> ,s 1 <br /> Cvwner/Authorized Agen; Signature Date (Revised 4/2015) <br /> 7 <br />