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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX// PERMIT# <br /> 1� IZ � ��1� IG�r�l '-3OZ----O & <br /> LEGAL for new construction: Short9Plat/subdivision J f /� _Lot No. (attach copy of long legal description) <br /> OWNER LY L L ( I VL( til/ ill Ica / h iLL Phone/E-mail +ZSR ze) z' I £Oj i— <br /> Address J 1 I Dft Q({ /IF/ City/State/Zip 't /l ' 1 Sj 1( 'l I <br /> APPLICANT: wner Owners Agent Contractor -Contractors Agent Tenant (must provide aletter ofconsent from the owner todowork in the space) <br /> CONTRACTOR 1,1ü mo VA;' L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building J.0 FAO/v.4 L O r f..c) L-' HEAT SOURCE: <br /> Proposed Use of Building (\A': i 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 /> la i< ( ..Z t7 Z50 <br /> - <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(4)of fixtures Show Number(4)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 I Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan j Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> — <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 1 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 complied <br /> with whether s fled herein or not The granting rtf 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 authord by the owneof 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 /> I 2 2,/` , <br /> z <br /> Owner/Authorized Agent Signature ( \ \. Date � <br /> (Revised 6/2012) <br /> /? <br />