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PERMIT APPLICATIGir <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 ADDRESS4 7a 6 - , r/o r PROPERTY TAX# iMIT#�r o <br /> LA) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Mark 6 /ernr ` , S i.�i1 Phone/E-mail(4Z.1 �S3C 627g��� /lrJCI 5_,14�/1017141 <br /> Address 47 </-orb©r L /P� City/State/Zip (ti La 9c20 <br /> APPLICANT: ' Owner Owner's Agent _Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR / ovek l—lPj�r JYI State Lic.# AP/ City Bus. Lic.# <br /> Address Phone/Email <br /> TERANTTIISTRESTIUM CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ;30 k_ <br /> Existing Use of Building 0 HEAT SOURCE: <br /> • <br /> Proposed Use of Building `-� a r- 4L 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 /> 1 i a 6jral�,� - —r f- ry <br /> 802 _F <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 /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater f 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 /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM l I Other: 144VA/V_, iR1 L+'Cite) <br /> Number of Heads Other: UMW cf ry ltriv <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 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 <br /> That I am authorized by the owner of this property 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 /> Owner/Autoriz'ed en Sigture Dae (Revised 4/2015) <br /> \[z <br />