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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.everettwa.org <br /> SITE ADDRESS:--+901-`1- 1601 S PROPERTY TAX# Ti s + On_ <br /> LEGAL for new construction: Short Plat/subdivision F'C‘QWA Q Y Its Lot NoWCI (attach copy of long legaldescription) <br /> OWNER se0-14.Q vac( (, +S `�, Phone/E-mail LI 9_5 615.-.5 2, <br /> J <br /> Address 12D S (-!�j e l.++VYICi L� � i`L( *10D City/State/Zip Cv e(�T` t\//A.t 91)4 <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 ( ,((l('?( ) 1.t. (� State Lic.# 19.hVJiq PO 17L$ity Bus.Lic.# <br /> Address g22. 61(,,k1,'4 f44J Q ; .S(( e Oa Sro laal(S Get W14- Phone/Email LI`23 34 5100 <br /> TENANT B• ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 "G g 5100 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ 410.00 <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): m I (g9 <br /> ( — c5 tArA <br /> 11711U 6Lis USe 50 P re-5S1( r) <br /> 1 R. <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 /> • <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 I" 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 specifiedit erein or not t ne granting oTa permit-does-not-presume to-give authority to-violate-or cancel the provision-of-any-other-state-or local law regulating-construction-------That I am a o•e 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 /> 4 , l 2.6 v4 <br /> Owner/Authorized Agent Signatur Date (Revised 9/2014 <br />