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• 0 <br /> PERMIT APPLICATION <br /> BUILDING/MEC HANICAL/PLUMBING/SIG N/SPRINKLER/DEMOLITI ON <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# PERMIT# <br /> is ry Z c)(4, 13 C Lf u I Li 04o270C% 111,61615-0/6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ft nfte Rf'✓1M-3* Phone/E-mail -Lc(o fj g -- (' 2,4 <br /> Addres s2.o rio Z fc-1 A Ne- it 3q 1 <br /> City/State/Zip,larti1^4-A6N cis 1&Z <br /> APPLICANT:_Owner _Owner's Agent _Contractor'�&-Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ( �;"e�-�E'f5 }'O�mC State Lic.# WaI c 13ToI AD Z. City Bus. Lic.# 65390 <br /> Address 3'9 2,2- -1+b P%i1E uF 3 2- L 7 0 1 Phone/Email IIZS-ZgO Z`I ZY <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 'ave l I,}ct cl <br /> ck- <br /> Phone/E-mail Let <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3 6© K <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 1)1,-k L C t Gas_ Electric+ Other <br /> Building type: _Single Family -1 Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane 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 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 j Dishwasher <br /> Clothes dryer 611 1 Clothes washer <br /> Range hood "\ Water heater <br /> Exhaust fan ! Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> 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 compl <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 1 am authorized by the owner of is 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 /> Owr/A th ri-ed Agent ' atur Date (Revised 9/2014) <br /> 7 ' <br /> VZ <br />