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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 ADDRES - 0\jam PROPERTY TAX# P RMIT# <br /> kl 1 C'�Q WI (0 61140 v i <br /> LEGAL for new construction:1-16 <br /> Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER q)-/���f_ ec-Kt Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractor's Agent X Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 609 AN(1OS hY» �JM <br /> ne O(ftt� �-> State Lic.#CC. GA 5T F- t l kQ?�)qty Bus. Lic.#0 4� 9 <br /> Address /"J \J\ \~ (V)k 0 fie— Phone/Email 1j3.Z© �7fi 73 —G6y 4 r I <br /> TENAN /BUSINESS NAME CONTACT FOR P RMI <br /> G5 49YD`frMO I. 00141 <br /> Phone/E-mail 2nd 3Q‘ 7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /C <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: -f'-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 rovided on the back): <br /> C .e,�1(ICC— CU �� �.�,d .Spit t✓ oc cz) orlsiood <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 j Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace j 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 j Backflow preventer <br /> Unit heater j Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration j Floor drain • <br /> Woodstove Grease trap • <br /> Ducting Roof drains <br /> Other ( Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads I 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 by the owner of this pro.- 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 /> O nor/Authorized Agent Signature Date (Revised 3/2013) <br />