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8 0 <br /> 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: (x�3O PROPERTY TAX# PERMIT# _ <br /> -I EVA LJ ZY�W 3 G03U lvSc7�; j j <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I �,� S/UUt�u✓�/(JJ ( L(_�, 1 Phone/E-mail <br /> Address Stib? /F �L�Y_r� City/State/Zip <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.# ��i tTln 14 E 611 City Bus. Lic.# I W <br /> Address Nr_ rlv'p� Phone/Email (y3 ZL <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> L`l�t�l <br /> Phone/E-mail(q7463- Ztl <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other_ <br /> Building type: _Single Family Duplex_Townhouse _Multi-Family X Commercial <br /> Type of project: New Addition Remodel Repair_T.I. Sign Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> kpL"r. (i)rY/sn)v( a yr-rvp 6,x/ctz&ml C INu11� l„w lrif- A),w C,14.1F J-ayt_C,iKZ c9-�'-&r7zs, <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 airs stems 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 <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other (Lt<Tuf Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby ce t' that I have re and exami d this application and know the same to be true and correct.All provisions of laws and ordinances goveming this type of work will be comp <br /> with whether s cified herei not.The gra ting 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 /> at I am authoriz by the o of this prope 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 /> Z - -Z�c1`1 �J Z <br /> OwnerlAuthonzed Agent Signature Date (Revised 9/2014) <br />