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PE.RMiTAPPLICATIGN <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/S PRI NKLER/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: PROPERTY TAX#i PERMIT# <br /> 00 LiU Z{- 02-00 0/ZO0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER L LL-G �y Phone/E-mail <br /> Addressp (�jp�( �/�ELI A�' 6"%`t �j�� City/State/Zip <br /> APPLICANT: Owner _Owner's Agent K Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to cip work In The space) <br /> CONTRACTOR St c,"/V 5 Mu -J State Lic,# ; -t City Bus. Lic.# <br /> Addre6�' tit . 2zPhone/Email � <br /> c <br /> 14 ESS ITAIW CONTACT FOR PERMIT ( Q J <br /> Phone/E-mail (7-o Z l 4Co n S�✓L�1`]uJ✓rLJ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (I <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: �!L New _Addition _Remodel _Repair_T.I.—Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): — <br /> Ob �q) 5ea-Ol>LaFP ���sT��i 6- o✓�✓� r�s� i���� <br /> 5�d r KCSST�r''' -ry fix, f c T �vlm ,�- P, <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 /> 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(inside bldg) <br /> Unit heater Urinal <br /> J Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting 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 18.27 RCW and 296.200A WAC. <br /> GiVvd-er-7Adthori gen Signature Date <br /> Revised 4/2015) <br />