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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: 1 Gj.Hn VP. se PROPERTY TAX# Pl ll�ff'"')�. C' -00 9 <br /> LEGAL for new construction: Short Plat/subdivision Ave. toots Lot No0102 (attach copy of long legal description) <br /> J" <br /> • <br /> OWNER SMQ OCIC('w tc itsS Phone/E-mail 25 ai i'-2.3 2,Qc0 <br /> Address (elp !Y i( \�q-0 I IOD City/State/Zip 5,ie(427i.A.( voor q?wit <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dowork in the spaac <br /> space) <br /> CONTRACTOR 4rX f)C (�1 �bi 3 t V'i 1 11i i' State Lic.# t t��y��if PL p 01. 221-:q <br /> ity Bus.Lic.# <br /> Address(R27 P,I taArd t4',t 't, ( ' r SV1U�l nis�l1 W34- Phone/Email 0,53 314 5 100 . <br /> TENANT B ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 43`Z 5 100 . <br /> BUILDING PERMIT APPLICATION1 CONTRACT PRICE OF WORK $ 1410. oO <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): d co _3L((, <br /> MO( yappire3s7c711 USS1 «a <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 goveming this type of work will be comp) <br /> wilTWfi cher specifieddiemm or not Th-b granting ora permirdoes not-presume to give authorityto-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 /> Owner/Authorized Agent Signature Date (Revised2W.4g14 <br />