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PE.RMI A PPUC .°TT uW% <br /> BUIL®INN/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DFMOLI` ION <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: J�FPERTYTAXff P RMIT# <br /> LEGAL for new construction: Short Plat/subdivisio Lot No. (attach copy of long legal description) <br /> OWNER rOCOW, Lk,��ri Phone/E-mail <br /> Address PO lCity/State/Zlp E7"VC?T t <br /> APPLICANT:—Owner _Owner's Agent -47-Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to Op work In the space) <br /> CONTRACTOR V �� -� --JTA-Z- , - State Lie,# VI✓ CiL2E�l City Rus. Lie.# &C�'7'1'�2j <br /> Address 2-« �trLc �C, �V W-A ( Phone/Email 2-,-) ZS2 <br /> CONTACT FOR PERMIT <br /> f2I757-3/1 �vtAi 6P tics=� t,4 ,�.. <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 0-o ccc) <br /> Existing Use of Building c� ee HEAT SOURCE: <br /> Proposed Use of Building it e emay Gas_ Electrics Other <br /> Building type: Single Family _Duplex—Townhouse _Multi-Family .A.Commercial <br /> Type of project: _New _Addition _Remodel 4 Repair.TJ._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> AUD & 'PN G t 5��'�%�i ( I� t�'�SS it a i Bio Po <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn __Alteration_2L 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 Lavafory(wash basin). <br /> Water heater I 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 /> l' Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting I Roof drains <br /> Other 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 16.27 RCW and 296.200A WAC. <br /> 4 <br /> �Iltsr/Authoriz Agent Signature Date (Rev/sed 4/2 <br />