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1ERMIT 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 ADDREPROPERTY TAX# IT <br /> � `� \...\\N`( � P• �"io tok. <br /> 0 <br /> 11 <br /> LEGAL for new construction: Short Plat/subdivision \J1916\ Lot No. ,_____'1 copy of long legal description) <br /> OWNER `VCx <br /> t\_ (/�lJa\ \�\ `"' \�`1�� Phone/E-mail LA S. C.t�Ct.�-{ y LiI ' <br /> Address ` k `V`, bru ` v-eV.eCity/ tate/Zip C'jjV‘ _\r'-t wa IcIADi <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 spa.-) <br /> CONTRACTOR V► -.\--- C��A <br /> co - t Vk,\MIly& tate Lic.# \ive c,i -, `a(nCity Bus. Lic.#O 651..% <br /> Address ( \1Q Q"111° Oii`.�\,+L, N\w\fr1 J g( b—Li Phone/Email C7 U <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '3S�[O •v- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building GasElectric Other_,_ <br /> ii <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): ! i <br /> \Ns,'N Com,%CJ.cc s Y� %S .k 0 v <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 <br /> Water heater Lavatory(wash basin) <br /> 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 /> 1k 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. <br /> with whether' eked herein or not.The granting of a•-rmit does not presume to give authority to violate or cancel the provision of any other state or local law regulating constructio <br /> T -t I a a •' y to perform the work for which application is made and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> .� 11- '-1 <br /> Owner/AI,thori d Agen ,.ature Date \ 1 (Revised 9/2014) <br />