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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: r PROPERTY TAX# P IT# <br /> �i/cr/ i / C6/�S' 7I2 /OoOos� P I y I -C7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER/7C7677J///6 �UTyoX/ y Phone/E-mail S/1s7/.5 9Zz2 <br /> Address Dx- /ry,7 City/State/Zip Z �CA- re.f/d6 <br /> APPLICANT: /Owner —Owners Agent _Contractor Contractor'sAgent Tenant(must provide aleper ofconsent from the orsnerto dowork in the space) <br /> CONTRACTOR • State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME <br /> CONTACT FOR PERMIT i-- <br /> g6'1/10 1// t/ <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 9a>d, Oz <br /> Existing Use of Building 5r/e. 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 /> ,,/9///6-e.--- AT 7 /-4777 <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 2 Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump —J 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 <br /> 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 taws and ordinances governing this type of work will be comp) <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�.t 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/•• o•zed Agent Signature Date <br /> (Revised 9/2014) <br />