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PERMIT APPLICATION <br /> BUILDING/MECHANICALtPL MB NG/SIGN!SPRINKLER/DEM LITI N <br /> CITY OF EVERETT PEI MIT.SERVICES; <br /> 3200 Cedar St„ Everett,WA 98201 425-257-8810 FAX 425-257-8857' www.everettwa.org; <br /> SITE ADDRESS: PROPERTY TAX if P •. IT <br /> CIC r. A S C c $ 0 oo1i O a <br /> a. .,' <br /> LEGAL for new construction: Short Plat/subdivision Lot No.;,..„ (attach copy of long legal description) <br /> OWNER 4 et 1M a v.t.44....- Phone/E-mail : tirr». lif.OS;. "3 'Cecis <br /> AddressI,...P." City/State/Zip <br /> APPLICANT: 'Owner Ownees"Agent 4Contractor Contractor's Agent *Tenant lmust pepvlde ale/aar m cnns•nt ati <br /> from�••owner•ur;esxar i the spate) <br /> CONTRACTOR C. _ f_...t �!' State Lin,#"go • 1 # eq city Bus.Lill#0Q ei g 0 <br /> Address 4',D1' 3�1 2� 1,t.. .�.`.i .4114 (A6 (,►8 phone/Email .. o\p . Qty <br /> TENANT BUSINESS ...E CONTACT FOR PERMIT 0,„‘ryNI t • Co AdytAkatwiel <br /> . <br /> Phone/E-mail CO ryvt-L 0;' ' 8 4 A , :.,,,.r ..: . SCA <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK > <br /> 191111111111111111111111 <br /> Existing Use of Building 4S, . HEAT SOURCE <br /> Proposed Use of s ink Gas�_- Betels then <br /> Building type: �" Single Family .Duplex Townhouse IMMtulti- only „„,,,_,Commercial <br /> T »eof'•roecl:.,- New Addition _ Remodel Re4air TJ. Sion S®Anker Demolition. Chane; of Use <br /> ORl��" t+� OF WORK(a �rret epees proved on the>tiack}: <br /> I )1t kr <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Atkin teration Repair Type of Project: New Addn Alteration Repair' <br /> $how Number(#)of,fixtures Show Number # of fixtures' <br /> NC--air handling units. i Toilet <br /> Forced air systems Bathtub <br /> Gas piping , Lavatory(wash basin) <br /> Water heaterShower <br /> GaSlirePlaoe i Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryerCIcilhes washer <br /> Range hood ''Water heater <br /> EXMuSt fan' Sink service/Oar/moo etc- <br /> ( Heat pump C", C.,4•140 3 Backflow •reverter <br /> Unit heater Urinal <br /> Boiler Drinking Fountain, <br /> Refrigeration Floor drain <br /> Woodstove Grease tra <br /> Ductin•^ Roof drains <br /> IIIIIIIIIIIIIIIIB Other....._:: 1.11111111111111 Medical Gad <br /> SPRINKLER/ SUPPRESSION SYSTEM Others. <br /> Number of Heade Other: <br /> I hereby certify that I have read and examined this application and know the same to be true anideorrect.All provisions,of:laws and ordinances governing this type of work will bees omp <br /> 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 /> I am authorized by the own r 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 2QQA WAG. <br /> "'I) Ci 1 <br /> • ner/Authorized Agent,Signature Date (Rev sed 9/2014) <br />