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a 'ERNIIT �4,PPL.�C�4TIC . � <br /> BUILDING/MECHANICAL/PLUMBING/SIG�V/SPRINKLER/DEMOL,ITION <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: PROPERTY TAX# PERMIT# <br /> i o;,� �,3 av� � �v����� oo s 3� zd�v� �i ��- -� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER ��' �j�U� � Phone/E-mail <br /> Address I� 1`� Z� 1�V�- vJ �`u���'�T City/5tate/Zip �U� �'T`� ��� ��Z ��-i <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor�5 A98f1t _T8f18f1f(must provida a letter of conseN from the owner to dp Work in ihe space) <br /> CONTRACTUR �W�}J.� � State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> ST� ���-+1 "Y �`�z�� ����-g'3L�:�� <br /> Phone/E-mail <br /> BUI�DING PERMIT APPLICATION CONTRACT PRICE OF WORK Z . <br /> Existing Use of Building ���` HEAT SOUR E: <br /> Proposed Use of Building ��� Gas_ Electric Other_ <br /> Building type: ,�Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: New Addition �Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ���-�� �J � 1�.��� ��p�1��� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _N w'�A�n _Alteration_Repair Type of Project: �Ne Addn'._.Alteration_Repair <br /> Show Num er(#)of fixfures Show Number(#)of fixtures <br /> A/C—air handling units �/ Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I 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(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Flaor drain <br /> � Woodstove ! Grease trap <br /> I Ducting � Roof drains � <br /> � Other Medical Gas <br /> SPRII�KLER / SUPPRESSION SYSTEM Other: <br /> 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 /> withwFf�iher�pecified herein or not.The 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 /> T at I am authorized by the owner of this propeRy 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 /> _ 1\)� 2`�, IS <br /> Owner/Au o ' ed Agent Signature Date (Revised 4/2015) -_� <br /> �1 Z <br />