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S'ERMIT APPLICATICC <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# PERMIT# <br /> 1► I -- -7 S i o07,r9Z ooze CO 1Y1 151 C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copyoflong legal description) <br /> OWNER�/t 7 170�T7 9C/T��/7 Phone/E-mail �2 572.3—,?, qz z zi <br /> Address7C/,.QX /53(7 City/State/Zip(Gid ,t/,9 9 2 / <br /> APPLICANT:,X 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 /9NoGI. ,4 State Lic.# if 1(3 1 Z. City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESSUSSSNAME CONTACT FOR PERMIT��ry�z y / 62' c <br /> g&" .)" 7" "� Phone/E-mail V25- 293}-6/J <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /6.00, D <br /> Existing Use of Building Jr/c,e HEAT/ SOURCE: <br /> Proposed Use of Building �/L/ Gas /1 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 /> ; tUt ) nekt,tY <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 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(inside bldg) <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 mad 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 compl <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 authorize"by the o er of this property to perform the work forwhIch application Is made and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> )/L—/ q 7/ sirs-- <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br /> 1 <br />