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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: i'2//7t/ 'b? L7 <br /> PRc PEERTY JA 12.0 120 P l� 11 - <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER /A, /Of / .4 Phone/E-mail <br /> Address 1/7) / City/State/Zip <br /> APPLICANT:_Owner kOwner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR t;/q /�1/f �� State Lic.# City Bus. Lic. # J .J <br /> Address 5 Phone/Email 4t .. 672-16Z--- <br /> icZl 3941 `7 — <br /> TENANT BUSINESS NAME C—ON�TACT�FFOORR PERMIT <br /> / �'i" / 1/V/Z- (Phone/E-mail fi-01 trYklrS (` 64 — <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (V(.) <br /> Existing <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building GA j2.-AGE 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 /> DESCRIPT ON OF WORK(additional space provided on the back): <br /> 221 y �' A-„rte t� <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 j Lavatory (wash basin) <br /> Water heater I Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood ( Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater j Urinal <br /> Boiler I Drinking Fountain <br /> 1 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 complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this prop-rty to perform the work for which applic tion is m e and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> t„ / �Z 2 /I <br /> Own /Authorized ent Signature Date (Revised 3/2013) <br />