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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> 615 3Th 51---- APPLICATIONS ARE ACCEPTED FROM SAM TO 4 PM <br /> SITE ADDRESS:,j---(loci_61442.11#- F o -t 41- /17)-PS PROPERTY TAX# P MITA+ ,off 7 <br /> iz sfr,�-f r►?a.riota. _ 2905 I 8c0ZZ61lop lr, L, i 1 —�1J�,7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ear f of-eieeett Phone/E-mail yu-Z51-3 U."1- <br /> Address P.0. Sac 53$ City/State/Zip (-_-,uar tit, WA 98ZOCo <br /> APPLICANT:X Owner� _Owner's Agent _Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR AgV l.if(cal 13 L(,I Id d jt'v) SIct. L&I Lic.# COE Bus.Lic.# <br /> k <br /> Address to&1' V e,,, Phone/Email <br /> TENANT BUSINESS N CONTACT FOR PERMIT (3rce.nden u)h,l f LkCr <br /> 4f 2.5-3Era-Geo(3 <br /> Phone/E-mail bW h.i1�+ per* «M'1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 39(O b O <br /> Existing Use of Building T rewaiircprn f2 HEAT SOURCE: <br /> Proposed Use of Building �fw60orzlwti fs_$17 int {��C.�tSr Gas <br /> hn_''__ Electric Other <br /> _ <br /> Building type: _Single Family Duplex_Townhouse Multi-Family _Commercial �-e+r' -rior-eaay <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 /> T awl".06 G '- dil to j &a <br /> l nar + -61e4-6-141. • nam <br /> e it-fraaca_ fa cre.r ,T- PA-Az <br /> &r,444-Ftca.#-fetsc-t: C.n Y-h-e_. (Vit S#re e.t ma-fine( 1244in, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Adds Alteration_Repair Type of Project: X New Addn _Alteration Repair <br /> .a Show Number(#)of fixtures Show Number(#)of fixtures(7 nptra.I y re s1r vnt'at c&.L /y) <br /> A/C-air handling units (o Toilet <br /> Forced air systems Bathtub <br /> N Gas piping 4( Lavatory(wash basin) (bizihroorri sinks <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> \Range hood I Water heater <br /> 'E haust fan I Sink(service/bar/mop/etc.) <br /> Hedtpump _ Backflow preventer <br /> Unit heater 2 Urinal <br /> Boiler '`, Drinking Fountain <br /> Refrigeration., I Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: WOO- f-yp J -r" <br /> Number of Heads Other:1(()I'111C(�1 In 'eIcc q 14)ara t- <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 willbecomplied LI I <br /> with whether specified 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 f� �� <br /> That I am authorized by the owner of thistproperty� to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. P IVB, <br /> -r/l 7f-t-raf &_ 11120/i Z. <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br /> t <br /> rz <br />