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likE <br /> RMIT A.PPL.IC.ATI <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 /> /7(f g 0 f . <br /> SITE2ADDRESS: i I PROPERTY TAX# PERMIT# . <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail ULA-C/4— t 1c3 U7t 1 ,Co✓I <br /> Address {"ZoC t Sb'-iti 51.. SE 94- c'v'e , X232®? City/State/Zip <br /> APPLICANT: Owner Owner's Agent Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR �''f rT$ d as> L-®,0,,y % om-7-`7aw Cz•_State Lic.# 561}- D�i4 zC l City Bus. Lica#cam <br /> R Phone/Email t N 6 ® M <br /> Address 7itrl, /3P - Sj � � � , C`'��2`�i� rot ��ONTACT FOR PERMIT � �j' �f� � L <br /> 24- .ST--Sal—642W - Phone/E-mail :.� .5Ni-0/`C OS 6-117 G , ce <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OFWORKT .a <br /> Existing Use of Building xirfi ( HEAT SOURCE: <br /> Proposed Use of Buildin• .iik•—Prx in,. <br /> • j ) Gas_ Electric f/ Other <br /> Building typ Single Family Duplex_Townhouse iliitrAk0 ommercial <br /> Type of project :/New _Addition _Remodel _Repair_ . . ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> NCt/U cR -- —A- 7W <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project , lew_Addn _:_Alteration Repair Type of Project jNew_Addn Alteration._Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units 3 Toilet • <br /> Forced air systems ) Bathtub <br /> Gas;,piping; 4 Lavatory(wash basin) •. <br /> Water heater i I Shower <br /> Gas fireplace ( Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> 1 Clothes dryer 1 Clothes washer <br /> Range hood Water heater <br /> . Exhaust fan 1 Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting 1 Roof drains <br /> Other. " Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> INumber of Heads ( I 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 complied <br /> with 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 /> That I am auth ri ed by the owner of this property to performthe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ri.L t.i c,,t,,,,...._ <br /> Owner/ uthorized Agent Signature Date (Revised 4/ I <br />