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PERMIT APPLICATIthl <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 /> J)7 ./9'*•sr sF. . F'v (4— 01501-blb <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER (i-r4_ GR(A./p. Phone/E-mail <br /> Address ;i t 7 /19 5r sE tjGc,t(-f- 98-443 City/State/Zip <br /> APPLICANT: Owner _Owners Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR ©t K...4A, State L-ic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK iti �CDr°-`2' <br /> Existing Use of Building <br /> 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 /> Roc' - /44&s •A/Or woke ( yr pL a Fwr— <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 Bathtub <br /> Gas piping 1 Lavatory(wash basin). <br /> I Water heater I Shower <br /> , Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher ' <br /> Clothes dryer Clothes washer <br /> I Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain . <br /> Woodstove I Grease trap <br /> I Ducting I Roof drains ' ' <br /> . I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and exa •n d 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,Th- •ranting of a permit does no • _-ume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> 1 That lam authorized ownej>.' •arty to perf•••• -work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /,- S.eA-f a-3 I <br /> 9 er thorize• Agent Signature Date (Revised 4/2015) <br />