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4111PERMIT APPLICATIRJ <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 // , PROPERTY TAX PERMIT# <br /> 2/2Aar, St4— .4 a a062enP2. e'O/O <br /> j 0q DSS <br /> LEGAL for new construction: Short fPllat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER v6�t� Ol/S-7/t,( '7/. <br /> ��tt /� /j/ > f�lfly0/C/� � Phone/E-mail y'�//$, G.S �, /� 2 <br /> Address 3/l/ 7 t-Qz.,1Y /_7V C City/State/Zip �v��C <br /> APPLICANT: 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 State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR <br /> � PERMIT I � <br /> Phone/E-mail 72 O <br /> � � 637) A71/01/47CV4//' o/e(7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .77,3:5 //'• <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of BuildingGas Electric Other <br /> Building type: _Single Family —Duplex Townhouse v'//Multi-Family Commercial <br /> Type of project: New Addition Remodel 'Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WAIRK(additional space provided on!he 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 ; Toilet <br /> Forced air systems ; Bathtub <br /> Gas piping I Lavatory (wash basin) <br /> Water heater I Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range i Dishwasher <br /> Clothes dryer i Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <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 j 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.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 /> • 75::// // <br /> Owner/Au '.riz•d Agent Signature Date (Revised 3/2013) <br />