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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 tf PERMIT# <br /> iZ P /17' ��z � a t�I-3C' C t <br /> LEGAL for new construction: Shod Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 2 T Jr? / g 2) �„„ C__ Phone/E-mail i� �rjQr �7 'J7 U/I���Glr�-� <br /> Address . ��/� C �L cL /Z., City/State/Zip .1,04,,,3/I01,,,ge 2zJ,9-- 9 E-?) F 7- <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR A' ) jam i'/ 4---Ziif2-5 G-[. T State Lic. # City Bus. Lic. # <br /> Address�//LZ /t,` • /1 e2 >1 L f Phone/Email �S — 7‘.6 /L' <br /> TENANT BUSINESS NAME CONTACT FOR PERMITITJ <br /> Phone/E-mail? �L 'LCl/e bet, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building }i>ji)n, HEAT SOURCE: <br /> Proposed Use of Building J i—A_ Gas Electric Other <br /> Building type: X Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler X Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): 11 ‘' Si"\-1'1— <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration Repair Type of Project: New_Adds _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems 1Bathtub <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 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 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 her • ot.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• the own-r of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCVV and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />