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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 /> SI ADDR S PROPERTY TAX# F :M <br /> re 10 it-40 <br /> LEGAL for new construction: Short Plat/subdivision Lot No:: (attach copy of long legal description) <br /> OWNER ;s,. k Vii �1 [1 verN Phone/Email 9° . 4 + C113 4 V3 <br /> Address , ;e..--" , City/State/Zip <br /> APPLICANT: ,Owner Owner's Agent 4contractor Contractor's Agent „ Tenant toast provide a letter et cement from the owner to do sorts in the pare} <br /> CONTRACTOR St.t✓ t„ 1.19 State Lid<f .rt,4Ct,FS »q--44 City Bus.Lic.#( + t is Q° 0 <br /> Address 1(!t,CM I-1' 4,4 9 t_ St40,,,,4,1k, 4 8 Phone/Email -At``! ta . <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 1 YY '1 <br /> .t( ,rr t. .. t", r,..4,-,...vsJuirs <br /> Phone/E-mai{;. ( t A-4 ✓ . yvw l{tlJi I Vit . C-o <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I NI 45 <br /> Existing Use of Building '2.1' SOURCE: <br /> Proposed Use of Building Scria Gas t/" !Electric Other <br /> Building type: ingie Family Duplex Townhouse Multi-i= ily Commercial <br /> T .e of 4roect: New Addition Remodel Re•air 1`.I. Si•n S.rinkier Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> alio.C.G. SI v t , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project. _New_Addis `" Alteratloh , Repair Type of Project: New ;Addis Alteration .Repair <br /> Show Number(#j.of fixtures Show Number(#J of fixtures <br /> NC—air handling units f Toilet <br /> Forced air systems ( Bathtub <br /> Gas piping Lavatory(wash basin) <br /> I Water heater (C.112.,,S) Shower <br /> Gas fireplace ' Kitchen sink 8,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 /> 11 Unit heaterUrinal <br /> Boiler Drinking Fountain <br /> • <br /> RefrigerationFloor drain <br /> Woodstove ..-.-..- 1 Grease trap <br /> Ducting f _ Roof drains, <br /> Other Medical Gas <br /> SPRINKLER if SUPPRESSION SYSTEM - Other: <br /> Number of Heads L Other: <br /> i hereby certify that I.have read and examined this application and know the same to he true and consist.Alt provisions of laws and ordinances governing this type Of work will be camp <br /> "h whether specified herein or not.The granting Ma permit does net presume to give authority to violate or cancel the provision of any Other stale or local law regulating construction <br /> I am authorized by the own r of this property to perform the work for ich ap tication is made and I comply with the Stale Contractors Law 15.27 RCW and 296.200A WAC. <br /> 4i <br /> �t <br /> . L ♦d <br /> it ner/,Authortzed Agent Signature 0 t (Revised 9/20/4) <br />