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0 • <br /> PERMIT APPLICATION <br /> BUILDII* G/Ii ECHA NICAL/PL UMBING/SIGN/sPRINKLERMEMOLITION <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: /! Ad <br /> PROPERTY TAX tt r PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision V�i Lot No. (attach copy of long legal description) <br /> OWNER AUL (/ V 11, <br /> Phone/E-mail <br /> Address V City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent X—Contractor _Contractor's Agent q_Tenant(must provide a letter or consent from the owner to do ww2orrk��inn the space) <br /> CONTRACTOR C �.. State Lic.# { S�I I City Bus. Lic.# u✓I <br /> Address Ul Phone/Email C v)I aI. co <br /> 16-5 1 <br /> TENANT BUSINESS AME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE F WORK <br /> Existing Use of Building n it I-•� HEAT SOURCE: <br /> Proposed Use of Building�� �lJ e��� Gas Electric_ Other_ <br /> Building type: Single Family _Duplex_Townhouse —Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> UP4ACE I xOTiNil 6/TS Ov►4-EF- IN TYE UL17') HOM5 NGWl NIDE ::�ItelffIT- <br /> V1�5stll�t�l\! <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 inside bldg) <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 Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examir this appllcation and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> with whether speclfie herein or not.The ranting 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 y the owner of i 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 /> Owner/A t or- d"Agent Signature Date (Revised 4/2015) <br />