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r <br /> PERM APP LDCAT1 N <br /> BUILD9 IG/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DH/PDLI BION <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:. 0 � h `' c PROPERTY TAX# `61.(A -0 <br /> I' <br /> LEGAL for new construction: Short Plat/subdivisionPcW Re,1ghk-s Lot No.L4tJ(attach copy of long legal description) <br /> • <br /> OWNERS' A • C. 0 Phone/E-mail ''JQ,b /5. 20O <br /> Address Cv� tt� ed !11('‘, City/State/Zip F.2_4I �-4JV14 C1?Z t-� <br /> APPLICANT: Owner Owner's Agent ,Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do murk m the space)} <br /> CONTRACTOR j I ae.-' lumbi . h)1JC1io C State Lic.# 11,i;4 ''vvl.`'1 J-71... r,City Bus.Lic.# <br /> Address I t!I�. t1 + k !k 0 o'wm'sI ./4 Phone/Email L/ZS- 3g 3 5100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 1-0,6 ?)/-IR - 5\00 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ) "�.0 <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 /> T •e of•ro'ect: New Addition Remodel Re•air _T.I. _ Sian Sol-inkier Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): c Le 0(.0 — 030 <br /> CSC ("tut 51A <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 handlin• units Toilet <br /> Forced air s stems Bathtub <br /> Gas •i•in• Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis•osal <br /> Gas ranee Dishwasher <br /> Clothes d er Clothes washer <br /> Ranee hood Water heater <br /> Exhaust fan Sink service/bar/moo/etc.) <br /> Heat sumo Backflow •reventer <br /> Unit heater Urinal <br /> Boiler Drinkin. Fountain <br /> Refri•eration Floor drain <br /> Woodstove Grease tra. <br /> Ductin• 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 authorized 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 /> ,J(� ;,-/YL-S / 2//2-// <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br /> /Z. <br />