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• S <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: ( _ PROPERTY TAX# PERMIT# <br /> 3Z Loc��`S S 1 o0/ -". 9c/') 'CO0 ,..., <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy <br /> of long legal <br /> description) <br /> OWNER �f // ` €2 7/ 6' �U7�d /7 / Phone/E-mail 12. cJ q�i Z-Zi <br /> Address f4 ZZ,/t" /f<' 7 City/State/Zip 6 " X.//1 9j 77 <br /> APPLICANT:X Owner s_�c�OOwner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR /�Nv /g/ 21 <br /> State Lic.#�NO(7F}C j'j )b 12_ City Bus. Lic.#O��%��y'( <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> S /t/z,y A/ <br /> g674/,G r `�� Phone/E-mail yG J 293 5-6/J - <br /> 7 7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ,/600, ern <br /> Existing Use of Building �i � HEAT SOURCE: <br /> Proposed Use of Building 5-/ /e 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 /> roplAct -6.A.Arnace <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn X 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 <br /> Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <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 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 comp) <br /> with whether s 'fled 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 ant aut o' ed by the ow er of this property to perform the work for hich plication Is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />