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s; <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: D Y/ Toth Ave S u.o PROPERTY TAX# <br /> Vind4 W O 9 <br /> LEGAL for new construction: Short Plat/subdivision Al pi ILS Lot No.1-45 (attach copy of long legal description) <br /> _ OWNER Se ca,((,j'(i(� Home S Phone/E-mail 1125 (36> ,goo <br /> Address i20y.) �J (—e` - via .N 100 <br /> City/State/Zip gJ (�2{�r q�°Lt o'-I <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 Prdithiad pI(/n')b%j i Pit-e4110 9 State Lic.# Atw` 'J y Ld1 i7L5 City Bus.Lic.# • <br /> Address k22. P I ca 4 Th, r sulk k 0 i S no Y ttr l r`I fh/4 Phone/Email /7 5'4 5-100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail X25 -- — 5100 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK • (a' ?i&, <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): LO OCe _ 02_9 <br /> at 4i (-Jo& i� sictreuzi <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 /> 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 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 authoriz-•by the owner of 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 /> Owner/Authorized Agent Sign ture Date (Revised 9/2014) <br />