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PERMIT PPUCATIun i <br /> • <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: ' 1 , PROPERTY TAX# P >06 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long,legal description) <br /> • <br /> OWNER -1')./.,,f, . C-7 7,J w�-- Phone/E-mail �:i-J`tri,,, A-��t,\.,/\'v Lc,-.1, <br /> Address ' ,,•: --Jr, -`7 T� IS. c. :✓L L'y7- g�1 1✓�/ City/State/Zip 1��/ ., t i ,,,,I,A S n- 3 <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 AE-- , .j 4r. , ( I1.-.al iG t o i_` -J State Lic.# City Bus. Lic.# <br /> Address • Phone/Email <br /> TERANTSEGINESSITATIE CONTACT FOR PERMIT <br /> h14 Phone/E-mail • <br /> ) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building /� r 12— HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> Building type: '-,C 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 /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Adds Alteration_Repair Type of Project: New_Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems # Bathtub <br /> Gas piping 1 Lavatory(wash basin). <br /> Water heater I Shower <br /> - I Gas fireplace Kitchen sink&disposal <br /> Gas rangeDishwasher <br /> Clothes dryer Clothes washer • <br /> I 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 I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting I Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / 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 /> 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 /> V/ <br /> Owde Thor' ed Ag�nt'Sig ature Date (Revised 4/2015) <br /> `1z <br />