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r crt�v�� � r►r r �ivr� � �v�. <br /> BUILDING/ME�-►NICAL/PLUMBiNG/SiGN/ �1NKLER/DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES � <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-2�7-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX tl PERMIT�t <br /> �Z---� � r„�� oo - � o�/�ovov <br /> � LEGAL for new construction: Short PlaUsubdivision � Lot No: (attach copy of Iong fegal description) <br /> OWNER�����// f�U�f/�v ��T�7d/Z PhonelE-mail ���Z�� , �� � <br /> Address�4�DX �,�� Ciry/State2ip��/�GC/T��I ��0� '� � <br /> APPLI CANT:,�Owner _Ovmers Agent _Contractor _ConVactors Agent _Tenant�m�:�aorba a ianer m cons�,c trom we owner to ao wor�c in wa sPaca) <br /> CONTRACTOR N��A State Lic.# ��� �5�b�Z Ci Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ,q�p.Y �E-L T-�/F- <br /> �i�C"1/"a!/ v/��'""' Phone/E-mail �� � J ���� ���`' ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��04 C.7. � <br /> F�cisting Use of Building J`�/�� HEAT SOURCE: <br /> Proposed Use of Building �/�/`� ' Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse _Multf-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Si ri S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION � PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Addn _Alteration_Repair Type of Pro}ect: _New_Addn _AlteraUon_Repair <br /> Show Number # of flxfures Show Number # ot fixtures <br /> A/C—air handlln units Toilet <br /> Forced air s stems Bathtub � <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater � <br /> Exhaust fan Sink service/badmo /etc. <br /> Heat um Backflow reventer inside bld <br /> • Unit heater Urinal <br /> Boiler � Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin • Roof drains <br /> Other Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM Other. <br /> Number of Heads ' Other. <br /> I hereby certKy thal I have read and examined thts appikatbn end know the same to be trve and correct.All provfsions oilawa and ordinances goveming thia type oiworkwAl be <br /> with whelher spe ' d herein or not.The granUng of e partnit does not presume to give authority to vfolate or cancel the provfsion of any other state or Iocal law ragulatlng consN <br /> That 1 am autho e y the o of Ihis property to peAortn the work forwhMh applVcaUon Is mada and I compy with'the State Contrectora Law 18.27 RCW and 298.200A WAC <br /> G-� � 'Z � r <br /> Owner/Authorized Agent Signature Date (Revlsed 4/20; <br />