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°PERMIT APPLICATI <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 ADDRESSOCCJS T 57. rv6--- ��`i/4 PC/�R9G"�o/�'on�' c�OD� PERMIT# (0 0q0 <br /> LEGAL for new construction:sttrShort/Pllat/subdivision Lot No. / (attach copy of long legal description) <br /> OWNER G�//vtt6/�r`/7 yOLV //tJ� �(/71-7 /.€ / Phone/E-mail / 'Z/,�G.J 2 2- <br /> Address 3/!J 7 C Q�,a " /7(�� C' City/State/Zip �v���77- .//1 <br /> APPLICANT: (/Owner _Owner's Agent Contractoror —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Av4/,Shy (19/1„rf,C' , State Lic. #A/,fLS// ` C 99:0.D/ City Bus. Lic.#,0�-j 5:j/ <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� <br /> // 11L/7/ <br /> Y / �'V Phone/E-mail V-.�JOC? 6370 /147Qj(//V —V77//9 O <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 33() f). i7) <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/u/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 /> NC—air handling units ; Toilet <br /> Forced air systems ( Bathtub <br /> Gas piping I Lavatory (wash basin) <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer i 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 j Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> Number of Heads j 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- •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 ' d Agent Signature Date (Revised 3/2013) <br />