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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 /> P IT <br /> SITE ADDRESS: PROPERTY TAXq � M # <br /> CI' q (-0,z(16, 41/ /._ ����� r�,�1 l 14 �� lC� I .3)I Q L '' l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWN ERj�� �G kv'I CSPhone/E-mail <br /> Address 6 Z7/1, ter/I ,„ lt„,,J/-714-- <br /> ,- City/State/Zip � / Ir./4 / <br /> APPLICANT: Owner _Owner's Agent 7'Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR/LG,,,I V S C1>�( jp/��Zd, / State Lic.#/1*--V 7/1 )---Q( City Bus. Lic.# <br /> Address c-(// )6F -s�i JGr Z? /'r /1 /t /?. hone/Email 7 -a7 VS—`. h Z <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �C <br /> mel(L/-(C; >cS Phone/E-mail C/ "2 L/ 77� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C`),( z"(;.Dc-) <br /> Existing Use of Building Caz7c/ HEAT SOURCE: <br /> Proposed Use of Building Sc.. 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 /> 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 /> A/C—air handling units Toilet <br /> Forced air systems ! Bathtub <br /> Gas piping - j 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 Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> FNumber 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 to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized• r"-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 /> 0 er/Authorized Agent Signature Date (Revised 3/2013) <br />