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PERMIT APPLICATION <br /> BUILDING/MECHANI AL/PLUMBINS{ IGN PRINKLER/DEM LIT O t <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: PROPERTY TAX a PE' IT .1 <br /> lb 5 M 40-404-, '30It. PEA AIT . 1 t" <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy oflong legal description) <br /> OWNER12 <br /> i , - Phone/E-mail � 5 ' fl . /3,...4 Lc 1 <br /> Address *err " City/State/Zip <br /> APPLICANT: Owner Owner's Agent XContractor Contractor's Agent Tenant(must provide a reherof consent tram the owner to do work ea the space) <br /> CONTRACTOR 1,, t/H'vves,:#..4--► , ,..• L State Lic.# .a t , t OCit City Bus,Lic.#C4 a gs 0 <br /> Address 4 t of y I24-0- "'Pt. _ rC.I ,i^f'T-‘.. `tel 0(tea Phone/Email Dkv 't'?t " <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT j x rrtt . t't x44"1 <br /> Phcane/E-maiij co ry,y, ..,w1f.+6l.�tr'M�"r, .A '1 Y' • CAi" -% <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I q •-j <br /> Existing Use of Building C" HEAT SOURCE <br /> Proposed Use?ding' ing Gas Electric Other, <br /> Building type: —Single Family Duplex Townhouse —Multi-Family Commercial <br /> T .e of,ro'ect: New Addition Remodel Re sea' k'T.l. Sian S p rinkler Demolition Chan.e of Use <br /> O SCRIPTION OF WORK(additional sonde provided on the:ba ) t ". <br /> - - " <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: �RewAddrt Alteration Repair Type of Project: New ..,Addn Alteration Repair <br /> Show Number(#)of fShow Number(#)of fixtures <br /> I A/C-- ir-handlin units°_,.,..--? Toilet <br /> Forced air syste s 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 /> s <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 /> l Woodstove Grease tra <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> w <br /> i Number of Heads Other: <br /> I hereby certify that I have read and examined this application end know the same to be true and correct.All provisions of laws and ordinances governing this type of work will becomp <br /> h whether hsopiezceifbyhtheereionwonr noott Th <br /> thie pgraetrtg toot paeprfeorrmmit thdoews snop <br /> 0nerlAutharixed Agent Signature rrewsmhe atogiiiCav <br /> • <br /> eGaouithisomyadto vaoatIe coomr cancel hthteh-epSrotvaistaiGnonoftraancytoorheLar wstaft8e.2o7r oCaWl laawndre2g9u6la.2ti0ng0AcoWnAstCru <br /> to <br /> t 1 <br /> Cate (Revised 9/2014) <br />