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PERMIT APPLICATION <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: 0 j e-Y* �J h;WROPERTY TAX# PI;RMIT i if061/ 10 <br /> 61 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. <br /> (attach copy of long legal description) <br /> OWNER JC{,/h G S �{3{ Phone/E-mail /0to—4/0(10"-6 9 <br /> Address City/State/Zip —Flier e i LOA $'161 <br /> APPLICANT:V 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 i1 4-1 State Lic.# 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 <br /> Existing Use of Building e'5 /C' L`�- t 4 HEAT SOURCE: <br /> Proposed Use of Building R e ) clt'i -)i q I Gas_ Electric Other <br /> Building type: V 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 /> ee12 ofeckt' r� l ir+4et-Le r,a <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 /> I 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 j Clothes washer <br /> Range hood i Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler I 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 authorize y the owner of this property to perform the work for whichapplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ow r/Authorized Agent Signature Date (Revised 3/2013) <br />