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it <br /> +ERMIT APPLICATIa <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 ADDR t \\..,„\ \ PROPERTY TAX# PERMIT# <br /> 1411D%- bol <br /> LEGAL for new construction: Short Plat/subdivision \ \A\Uk4:1t Lot N( tanacri copy of long legal description) <br /> OWNER ?CA l.Jl\c \?../`JR 't Phone/E-mail I S- 1-k.* .-Q6-1-4 4 Li <br /> Address -1(/ `\ h�1`� 1� -Q`/ Ci / tate/Zi <br /> APPLICANT: Owner _Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the spal <br /> CONTRACTOR \ ' CCOSA— n .�W\f\Okw tate Lic.# Nvest-�'C \ \ (PCity Bus. Lic.#063136 <br /> Address1.--\\4- �TQ \ t '` c"21 Yd �C\�v�� 3g to,--�i b 3LD <br /> ' <br /> ZT, Phone/Email C?U <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> i <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '3S T O -("-- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building GasElectric_ Other„ <br /> Building type+'\ofSingle 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): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION `C <br /> Type Project:ect: _New Addn <br /> 1 _Alteration_Repair Type of Project: _New_Addn Alteration_Repair ! i <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 /> I` I Number of Heads Other: <br /> I hereby certify hat 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 corn ii <br /> with whether-,ecified herein or not.The granting of apermlt does not presume to give authority to violate or cancel the provision of any other state or local law regulating constructio,', <br /> T : I a .` •'zed• •,,ner o •-'y 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!- ,thori.-d Agen , .ature Date (Revised 9/2014) <br /> (2122' <br />