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°PERMIT APPL <br /> ICATIA <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 /> 832 L//✓c6✓ %T. !/6,4-/7 ///f9 5/5-9'2_ 06/ v,�`7o (:)o,!iV (0 03S <br /> LEGAL for new construction: ShortlPllat/subdivision Lot No. (attach copy of long legal description) <br /> G� / <br /> OWNER ///�iE/�t‘77- /yQ //t1� /4(/77-7. /./2,€ Phone/E-mail <br /> y257257 �z L 2- <br /> Address '/lam 7 eQL�UpY' /VCity/State/Zip v�Z c - .//1 <br /> APPLICANT: !/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 M'7( Sir (,14,/,..17j • State Lic.#a/f(J- ` qq ),b I City Bus. Lic.#0j�17` <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> / f/ V/ Lel! Phone/E-mail 7 Zr.5"-D61:36) /6d��/ (7/7�- 4e6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��e)[9, rz <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 /> .S/Q/N G <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 I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer i Clothes washer _ <br /> Range hood I Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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-uti•rized 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/Au .'rd Agent Signature Date (Revised 3/2013) <br />