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• <br /> ItiERMIT 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 U PERMIT# <br /> //-0r/'/ 5 f i4-7F % /tiff 00% c) 14(6 -0 3!0 <br /> LEGAL for new construction: ShortPlat/subdivision /J Lot No.5'25-72'57,(attach copyyof long legal description) <br /> OWNER L-1—V /f(� �/ -//// �� /�/ /� /7 7 Phone/E-mail �Z 7. 7- <br /> Address3/ 7 (a /�(/ C. City/State/Zip 1�� 7 f.//1 <br /> APPLICANT: Owner Owner's Agent <br /> _Contractor4 _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR'/�i7(S, ��,i/ 7, , State Lic.#�ae,,Syt�t�WUN City Bus. Lic. #j)S- ?S// <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Q / <br /> Phone/E-mail %ZS"Sor? 630 /46,/f///�el/f//9. 4Q6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��4-2' <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 /> •--5-/D//A/6 <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 /> A/C-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 Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 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 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 state or local law regulating construction <br /> That I am-ut,•rized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> lZ <br /> Owner/Au ' d Agent Signature Date (Revised 3/2013) <br />