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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 /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> -101, 3¢�e,C�*- 5k,.,d, ?820 oo31 zsoo 10010c)/-70t W 1,665—op?, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Trot ��{�f(E� Phone/E-mail Zp(o 852 137So *oyeiserteep044,►,c,a r. <br /> Address 7O Ka_ <br /> I/ RLvd City/State/Zip 6;.cy�f{' 4 982-6'$ <br /> APPLICANT:7K Owner _Owner's Agent _Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 140 Q p�„� � State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 7.06 852--t37toyZke..r e.q,n..a�1,,�C„pp` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK / J <br /> Existing Use of Building 5FR HEAT SOURCE: <br /> Proposed Use of Building S F Q- Gas x Electric Other <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): <br /> cc)?4<</Ntprovt-- eNja-s`k✓� -�r•�.,�n: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 ow Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater .hower <br /> Gas fireplace hen sink&disposal <br /> as range Dis' asher <br /> C• hes dryer Cloth--washer <br /> Ran.: hood Water h=ater <br /> Exhaus -n Sink(se e/bar/mop/etc.) <br /> Heat pump Backflow pr-venter(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Founta i <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYS M Other: <br /> Number of Heads 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 comp <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 constructio <br /> That I am authorized by the owner of this property 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 /> Sly 2 /5"" q <br /> ner/A ;,.• ed Agent Signature Date (Revised 4/2015) <br />