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• <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.everettwe.org <br /> SITE ADDFtESS: r <br /> ERMITktipt5mT6xot a�q �ooE jo 0 (27261 <br /> LEGAL for new construction: Short PlaUsubdivislon Lot No. (attach copy of long legal description) <br /> OWNER �� I n c ). en Phone/E-mail • • (C2:.(si <br /> Address city/State/Zip <br /> APPLICANT:_Owner Owner's Agent X.Contractor Contractor's Agent T <br /> g anon((mum(prOvlUe letter of co omen(Dorn the owner to do work In the dpece1 <br /> CONTRACTOR State Lie,# Gay B .Lie.#d o� $a� 0 <br /> =.ter L! 44 L ��t. <br /> Address Coll 44. I-(_ (I 4 r7 t Phone/Email l„� g • p/ <br /> TEN NT BUS ESS NA E ICYONTACT FOR PERMIT j& mi L. <br /> Phone/E-mail.) }'y'L i , r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 0a <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Builds Gas electric Other <br /> Building type: ✓single Family Duplex Townhouse _Multily _Commercial <br /> ,Type ofproject: New Addition Remodel _ Repair 'KT.!. Sign , Sprinkler Demolition Change of Use <br /> D SCRIPTIOw N;F WOR(0. ;0 l space provided on tpe eck); j �i <br /> �KJ,�, 1 C J� -a c� 1 S I y <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New /lddn Att:eraflon tiepair Type of Project: New_Addn _Atteratlon Repair <br /> Show Number(#)of fixtures Show Number 09 off hure9 <br /> A/C—air handlin. units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> _ Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range <br /> Dishwasher <br /> Clothes dryer _ Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Back-flow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> r-- Woodstove Grease trap <br /> Ducting • Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have reed end examined this application and know the same to be true and correct,Ail provisions of laws and ordinances governing this type of work will be comp <br /> whether epecttted herein or not,The granting of a permit does not presume give authority to violate or cancer the provision of any other state or local law regulating construction <br /> , Thb I em authorized by the own r of this property to perform the <br /> work r which pp/liicaation is made and t comply with the Stats Contractors Law 18.27 ROW end 255200A WAC. <br /> v/ J I L" <br /> • ner/Auth•rrsed Agent Signature Date (Rev/sed 9/2014) <br />