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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 If I PERMIT# <br /> 300 3 W. C-41411.-)0 cam. ... . .__ D 16 .06 2,. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER IJOt.`=1**-/G► Phone/E-mail 4#35 ,x) <br /> Address '2jC)O"5 4J, C,+ ta*JCI tZ.O. City/State/Zip eV ct ri–Gil-- 'WA 9.8 <br /> APPLICANT:—Owner .24.Owners Agent Contractor Contractor's Agent Tenant(mustprovidealetterorcorsentfromOatownertodoworkin'hespace) <br /> CONTRACTOR j t..h,Arti State Lic.#13r0t:V t-%C.0 1'c 41JC..city Bus.Lic.# <br /> Address 304.)sy 4J- C45140O W. ,Phone/Email WC.'- (011 <br /> 'I'DANT'BUSINESS NAME " _ CONTACT FOR PERMIT <br /> Phone/E-mail 4,02-5--30t r0t^' 'S <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building t-Hk"z..t I C.41 L, HEAT SOURCE: <br /> Proposed Use of Building t-1 sjhr Gas Electric Other <br /> Building type: Single Family Duplex Townhouse ,.; Multi-Family ; Commercial <br /> T pe of,ro=-ct: New Addition Remodel Repair „Ti. ,Sin Ssrinkler semolition Change of Use <br /> DESCRIPTION OF WORK(actdrtionat space provided on the back): <br /> 01.-A. � !' -)A.. vtt.... c tic t'441-+1•3ct t30.L,,0e IJ GI 4 4c5— <br /> 64) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration Repair Typo of Project: _New_Addn Alteration Repair <br /> Show Number(N)of fixtures Show Number(Ni)of fixtures <br /> ANC--air handling units I ,, Toilet <br /> I Forced air systems Bathtubs <br /> Gas piping Lavato wash basin) <br /> Water heater Shower <br /> ' Gas fires ace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> ( Clothes dryer -Cothis washer <br /> Re .e hood Water heater <br /> Exhaust fan Sink service/bar/am. etc' <br /> Heat.ump Backflow «reventer <br /> nit heater Urinal <br /> I Boiler 1, Drinking Fountain <br /> I Ref-R eration Floor drain <br /> I Woodstove Grease trap <br /> t D I.. Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM' f Other: <br /> r Number 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 tits 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 authorized by the owner of this properly to perform the work for which application Is made and I comply with the State Contractors Law le 27 RCW and 298 200A WAC, <br /> .,,z,,,j,(4.:)' ., LAdt 4 --'—' kV/V/1' <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />