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• • <br /> 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: P RMIT# <br /> 6/0 /N1��IV PROPERTY TAX# <br /> ov47.5 Azov/vv c o Jv l -off <br /> LEGAL for new construction: Short Plat/subdivision <br /> '/ / Lot No. f (attach copy of long legal description) <br /> OWNER ZrVon637-46di <br /> f,2/ d(17:/6'/7/Phone/E-mail 2 92 Z. <br /> ddress ;F., box /5-Y7 City/State/Zip ff206 <br /> AF'PLI CANT. /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 6/M • State Lic.# City Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT r— <br /> none/E-mail/G sr.-7L5f‘j9c) ,eON/t/&---1//9`l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '5am9.57Q'D <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas /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 /> 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 _ Show Number(#)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems 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 /> Range hood J Water heater <br /> Exhaust fan _ Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / 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 compl <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 a th• ed 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 /> Owner/)zed Agent Signature Date (Revised 9/2014) <br />