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lit)ERMIT APPLICATIA <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:_ 7 PR #PE TY TAX PERMIT# <br /> .� % '7 >-`'/ - _ e-K / G✓, <br /> t 7- 4 YS Z' D 2/ toeO coI V' thJ ' (0"03 <br /> LEGAL for new construction: ShortlPllat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LI--/e.�0% O/ ///r !/ Z —� <br /> /,) /�p// � �(�� /� � PhonelE-mail 5'2' .5--, G �,�' � 7 �. <br /> Address /!/ 7 (la.,U T" /7V City/State/Zipt_. ---KZ-76---/7.- '.f,/// <br /> APPLICANT: //O,A�w//ner 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 vv 7 5 j7 ( C��e%3 / �. State Lic. #l-1'✓r,�(�//CC/�lj�UJ�City Bus. Lic.#0. --.1. 5-77' <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT --'—' ' / <br /> ,37-7/1/ /7/ 4:-.7-74'j Phone/E-mail (/1'3-1-',0 �J?O AW/47e�✓//,'-7. O/6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f,',S-2,ci. 'T z <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building / Gas / Electric Other <br /> ✓ <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 /> 5/li'%//L12 <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 /> I I A/C—air handling units Toilet <br /> — <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 I Sink (service/bar/mop/etc.) _ <br /> I ( Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler i Drinking Fountain <br /> Refrigeration ( Floor drain <br /> Woodstove I Grease trap <br /> Ducting j Roof drains <br /> Other Medical Gas <br />' SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> 1 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-ut •rized 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 296.200A WAC. <br /> t I� .1'7 <br /> /� <br /> Owner/Au '.ri -d Agent Signature Date (Revised 3/2013) <br /> i <br />