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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/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: A,, f `,l <br /> PROPERTY TAX# PI1 �3 <br /> 11 bi Z• e- -r rceAq LI.At_ Z"T g 1 4 tztrri <br /> LEGAL for new construction: Sholat/subdivision I Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip -(O® 44 61'4 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to .1.rk in thl!e space) <br /> CONTRACTOR 'Q..; T 0000ANt6 ttJtG SJGS State Lic.# (2-T14OOD Og� LCity Bus.L' #�tI5/G <br /> Address (�j�00 1ZT •A`16 soti+t'r4 56-#Trr.G bt/A c111c7 Phone/Email '2.0(. ,12E '09tIo <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ©Kn l IVUtf 1Ay SGitsct;t..`� 2.0(.0 •72.fvrO4l� <br /> Phone/E-mail J.S c krieloVigy'kin Ce •Co <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK \, ba, <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•r•• - " — _ _ _ - • • - _r-mo l ion Change of se <br /> P CRIPTION OF WORK(additional space provided on the back): t 1,1 STmu t,A-r-io N o• A&S(4 t.. WET C tidv'nt C t- <br /> P.%e.E StkPPfLES515-- vvx r Ai-r-c K ITCt1EN f 4©oj, o re r• jI .zA 0%/ • <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 /> NC-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 <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting - Roof drains <br /> O Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> 9 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 compi <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 owne 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 /> 1f /3i201 7 <br /> owner/Aut rized Agent Signature Dat (Revised 9/2014) <br /> 11 <br />