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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 tt PERMI,T f0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> OWNER MO+.,"'"1 Phone/Email 4 138 <br /> Address 300.3 W C•heStt-10 ItaCt. City/Stale/Zip eN€(Z-t,11-C" W A 9.82..03 <br /> APPLICANT: ,Owner j4 Owners Agent Contractor Contractor's Agent Tenant{must provide a teller of consent from the owner la da work in the space) <br /> CONTRACTOR r -I, State Lic.# t't GG 1.4241,1C-Cit Bus,Uc.# <br /> Address -3>00'2j W• t5JO . Phone/Email .x,iyL- ld4.411 " <br /> ..... _g r ..._ . .`. r. <br /> • - ONTACT FOR PERM <br /> Phone/E-mail 4'7-6-430t-2-84343 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Oirtct ' - HEAT SOURCE: <br /> Proposed Use of Building SIA Gas Electric Other <br /> Building type. Single Family Duplex Townhouse Multi-Family Commercial <br /> T pe of.rolect. New Addition . Remodel Re«• T I', Sian Sprinkler ' a'=Minn Chane at Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> t n s ("IC C4.311/ <:, taut erg C , 4o-- -3 <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(k)of fixtures Show Number of fixtures <br /> C-air handli units i Toilet <br /> Forced airs sterns 111.11111111111111111' Bathtub <br /> Gas u•t Lavato was basin) <br /> 111111111111111111 Shower <br /> Gas tire,lace r11.11111111111 Kitchen sink&dis.osal <br /> Dishwasher <br /> lothes d er I Clothes washer <br /> Ran;a hood 111111.11111.11111 ater heater <br /> 1111111111IIf_ Sink servicelbarlmop/etc.)` <br /> • Backflow r.reventer <br /> Unit heater nna <br /> i Boiler Drinki Fountain <br /> I Refri=enation 111.11111111111111M Floor drain <br /> Woodstove Grease Ira. <br /> DuchRoof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSiON SYSTEM 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 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 stale or locat law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application rs made and I comply with the State Contractors Law t 27 RCW and 298.200A WAC. <br /> r e <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />