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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.everettwa.org <br /> SITE ADDRESS: laat g5-4, M lj sw IPROPEP7,fTAX M^ W I PERMIT#rep <br /> C J 0 <br /> LEGAL for new construction: Short Plat/subdivision, cam• LotoN-oo.C.tJ-� (attach copy of long legal description) w( <br /> OWNER .%1\'‘ <br /> ate _ ,te I r' ,,a\) Phone/E-mail (99 )-NU r �( /oc <br /> Address ' U c. JIJ�=;ri- l City/State/Zip 'Tt . iiuk c3/890- <br /> APPLICANT: 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 h t " t'e�tl l AL- State Lic.# V\II\bSH el- k City Bus. Lic.#046150 <br /> iCG <br /> Address f (a`lf 4 ): C Phone/Erna Lia-s-)a <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail tfY1tCkiVC450: C >1 1 ,11 ,tl'\ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK CAGY% =' <br /> Existing Use of Building HEAT SOURCE: <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 <br /> the back): <br /> 1 `��( (i•1 ( iv (v a -uft�/ <br /> 1j <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New KAddn _Alteration_Repair Type of Project: New_Adds _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> I A/C—air handling 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 Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove i Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I <br /> I hereby certify that I :ye rea a d e ,fined I is ...lica on and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> with whe er speci-•. herein or ot. gra ng.f a p. it does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Tha a; =uthoriz.. .y the n r of -pro •rty .pert, the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � I S131Ale <br /> 0 n I ; t'•r"e• n If • Date (Revised 9/2014) <br />