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Sep 02 2016 10:30AM Washington Wat Heaters 8663757454 pa 1 <br /> PE =IGN/SPRINKLER/DEMOLITION <br /> CATION <br /> BUILDING/MECHANICAL <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-6857 www.everettwa.org <br /> SITE ADDRESS: 1 O 0 ! � ``{__ ROPERTY TAX 41 b(C.C�O PERMIT# <br /> o lV ''YY S <br /> LEGAL for new construction: Short Platisubeivision Lot No. (attach copy of long legal description) <br /> OWNER [�.S PPhone/E-mail - z Q'- �3ple3 <br /> Address l6l—t � � City/Stateop �b <br /> APPLICANT:—Owner _Owner's Agent ,r_ff Contractor `Contractors Agent _Tenant(mu3t Provide a letter of consem from tie owner to do Wore in tie space) <br /> CONTRACTOR Q5h/n riL�Lf t( State Lic.# l�� {� City Bus. Lic.# <br /> -rti v,��f ;�Lt �X7 �yr.Ln,n l/l �fl� (� <br /> Address 0 `/m O v ke {1 fi l/ 1N d(/ p • Phone/Email {� / �� wQ N� ✓QCT Y� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT / !G <br /> �J <br /> Phone/E-mail Q <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas tc <br /> Building type' _Single Family Duplex`Townhouse _Multi-Family _Commercial <br /> Type of ro eot: New Addition Remodel Repair T.1. Sin S rinkler Demolition — C>—ian e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> ) Z'4MA� (5j <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project; _New_Addn _Alteration_Repair Type of Project: _New_Adds __Alteration_Repair <br /> Show Number # of flxturos Show Number(#)of fixtures <br /> AYC—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Range hood IWater heater <br /> 1 Exhaust fan Sink service/barlmo /etc <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler <br /> Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medi;al Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other- <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application a d/know Ule sane to ba true and correct.All provisions of Iowa and ordinances governing this type of work will to a e�mpl <br /> i wit Whafhef specmed herpin cr not.Tito granting Of a perntlt 8$not pfocu mo to gve au th orTty to viola to or eontel iho provision of any other state or lofral law tepula ting construction <br /> Tho am aulhorite�try t e owner of thi�pozf�m rk forwhlchappticaaon is made and I comply vnth the Slate Contractors Law 18.27 RCW and 2P8.200A WAC. <br /> G <br /> caner/Authorized Argent Signature Date (Revised 9/2014) <br />