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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ,1 <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS:_ PROPERTY TAX# PERIWIT# <br /> f �-ca GLIM i 1- V t1 _ ( I 20cf DOS <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER C rcj 4. Lort+ . Wal vv1'/ Phone/E-mail 4;<6A-I 5.50,,i2- <br /> Address <br /> .50,ZAddress 42 /4-d /1./SAlf r� City/State/Zip (� V€,vejt- I.A � Gla2Q3 _ <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 o\Al Jtl€Y L&I Lic.# COE 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 57/ 5oo (2(00I <br /> Existing Use of Building' e..stc eo-I-1 Lia(,-' HEAT SOURCE: J <br /> Proposed Use of Building11‹..:j e c 1. tt 6-k.-- Gas_ Electric t Other <br /> Building type: V'Single Family Duplex Townhous _Multi-Family _Commercial <br /> Type of project: New _Addition Remodel V Repair_T.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):D V-,9W Qi p1 n4/�t-, �Q ci-riC„ ) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _NewAddn _Alteration'/Repair Type of Project: _New_Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units I Toilet <br /> Forced air systems I Bathtub <br /> l Gas piping Lavatory(wash basin) <br /> % I Water heater Shower <br /> I Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hooda eeat <br /> r er - - <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 /> r— <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 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 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 <br /> 0 ner/Authorized Agent ignat Date (Revised 6/2012) <br />