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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.evereitwa.org <br /> SITE ADDRESS: PROPERTY TAX# P MIT /ry <br /> .. V� �. C� INQ � � 4p �� � .����� v . <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER ��E(N� Phone/E-mail <br /> Address �00 3 W. C'.A�S INO RO• City/State/Zip �vC��t'?` WA `�'8 Z o3 <br /> APPLICANT:_Owner �Owner's Agent _Contractor _Contractor's Agent _Tenant�must Prov�ae a ieaer otconsen�trom u,e owner�o do wor�c in�ne spa�e� <br /> CONTRACTOR }�OF FMA(� � State Lic.# �,G. �O /(J E City Bus.Lic.# � �S <br /> Address 3 do 3 Y+�. GASt�to RA� Phone/Emaii � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �h�L (i�?I,A�E,r2TolJ �Qo£�Nfq <br /> gt'��11�� Phone/E-mail �{25• 31�j ��j2 pavt. .�jrarh�Qr�►t Z��fN .-G'AVN <br /> BUILDING PERMIT APPLICATtON coNTR,4cT PRlce oF woRtc�•5bo�ooa.oO <br /> Existing Use of Building �`'�ANV�A�."N(�-lt�� HEAT SOURCE: <br /> Proposed Use of Building MAµV�A.G'CO(t.f�G Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Mulfi-Family �Commercial <br /> Type of project: _New Addition Remodei Repair T.I._Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(addifional space provided on the back): <br /> REc.oG�('�on� o� �ytt$T�NG� PA�N"f M�X �4�E�4 �Rowi SOv'�H- Of 40—`3'7 tNTo <br /> T{� tNT�12.aot2. OF �0 3?. Tk}� S'ccaP� OF �vorLlC WI�V Jf�CL✓fJ� ACx-tF'�'[�CTurC�iGl <br /> MECHANICAL PERMIT APPLICATION PLUMBtNG 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 Bafhtub <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 Fauntain <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 i Other: <br /> I hereby certify that 1 have read and examined this application and know the same to be true and correct.A�I provisions of laws and ordinances governing this type of work will be complied <br /> with wheiher spec�ed herein or not.The granting of a pertnR does not presume ta give authority to violate or cancel ihe provision of any other state or local law regulating construction <br /> That I am authorized by the owner oi this propeAy to pertorm the work for which application is made and I comply with ihe State Contractors Law 18.27 RCW and 296200A WAC. <br /> �? �,�v,. <br /> !✓���� ____—' <br /> Ow r! uthorized Agen Signature ate (Revised3/2013) <br />