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0 • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBIN GIS IGN/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: • r —F ROPERTY TAX 4 PERNUT# <br /> 1AA,J ✓� <br /> LEGAL for new construction: Short Plausubdivision Lot No. attach copy py of long legal description) <br /> A <br /> OWNER I C PhonelE-mail C -G <br /> Address (4v <br /> V _ ciryrstatelzip tt`'y Gam. /:� <br /> APPLICANT--Owner _Owner's Agent X—Contractor —Contractor's Agent _Tenant(must provide a letter or conserrt from the owrrerto do work Ir the space) <br /> CONTRACTOR C ' State Lic_# j/l <br /> �7 City Buz-,. Lic.# t� <br /> Address !U ' "1 C'l Phone/Email J <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail- l C�/a, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 42 50 —^ <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building <br /> Gas Electric Other <br /> Building type: _Single Family _Duplex Townhouse _ _Multi-Family _-__Commercial <br /> T of ro'ect: New Addition Remodel Repair T.1. Sin—Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(addfTionel space provided on the back).- <br /> VA-)&41Il4-�Co�, Q— C QACAv <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New—Addn _Alteraltion_Repair Ty pe of Project.: _New_Addn _Alteration_Repair <br /> fix <br /> Shaw Number(#)of tures Show Number fll of fixtures <br /> A/C.—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas pipingLavatoa fwash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8.disposal <br /> Gas ran e j Dishwasher <br /> Clothes dryer Clothes washer <br /> .—Range hood Water heater. <br /> Exhaust fan i Sink(servicelbar/mop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater 1 Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other L` . Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I Fereby 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 cf work will be comp <br /> with whether specified herein or noL The granting of a permit does not presume to give authority to violate cr cancel the provision of any other stale or local law regulating construction <br /> Ihoriz d by the owner of this property to perfcrm the wTc- <br /> OwTierlAuth"T <br /> for which application is made and I comply with the State Contractors Law 18.27 RCVV and 296.200A WAC. <br /> h� 3 <br /> zedAgent Signature Date (Revised 9/2014) <br /> Z'd e0gIZ09L 0L 1nf <br />