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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 ft 1 P RMIT#r'° 2vc. �i'�/ 'i dG�—DIZ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 476 Cj rt-tx-e, Phone/E-mail (-f('2j 3/ c , 7r <br /> Address <br /> City/State/T.hp <br /> APPLICANT:_Owner _Owner's Agent _Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do wont In the space) <br /> CONTRACTOR /14 oce, f7(t„r-t h c`e State Lic.#Moes'PPaf- 3 j 0 City Bus.Lic.#OS 3(0 3 S <br /> Address 17515 `i( S f- 5 Snot.m..SL, 11/2 9 Z'tc) Phone/Em I �36oavg..TENANT BUSINESS NAME 1 rtev1('t P-f 110-4r7, a <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 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 /> 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 1 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 Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater - <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater I 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.Ail 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 by the 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 298.200A WAC. <br /> I0 —/S� <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />