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4 <br /> 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: 1-101 '10 th �V£ S PROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision Pc\Plt tto t s Lot No.1—J (attach copy of long legal description) <br /> OWNER S�(14.Q. Pac( L y S Phone/E-mail 14 9_„5 (:j51j 'Z y <br /> Address 1217 5t✓J r..Jv-e vvvi t I \,oc,q- IOD City/State/Zip ( J 2(.e4-44, W,o. a 2.04 <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 Fimu need 19143)3 State Lic.# OMAN PLA, -]c ity Bus.Lic.# <br /> Address i g22, P�IIt ( r dprkker su(j.e r sw,honk hi Phone/Email 42'5 314R 5[00 <br /> TENANT B• ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 f O ID . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $t4-17.( C� <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 project: New Addition! Remodel Repair_T.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): a_ u,ol0 —C) <br /> a 1- <br /> /110( uSe -are Ya pp re3s7 sc711 <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 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 /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> I t" 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 comp) <br /> with whether specifld herein or nor I he grantingcrapsrmit does notpresume to-give authority to violate or cancel the-provision-of any other-state-or-local-law regulating construction---------- <br /> That I am auth. - •y the•,•''er of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> /*' <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />