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• • <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: � � � 4vc PROPERTY TAX# oSo / PERMIT# <br /> 2.303 0 378 Z r <br /> - �Q <br /> LEGAL for new construction:TShort Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Oct,l G & -J 00'- n CC /�Q.tt di f'r Phone/E-mail y�r 7Y2,'0/9/ C SOr.n'111'e. @5✓"a 11. Coni <br /> Address / 2 9/y 6 O f4 i4 v c W City/State/Zip L y w a n d IA/A 9 2a3? <br /> APPLICANT:_X 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 PERMIT <br /> Da lc CkC,(Adr'crc <br /> Phone/E-mail c.12 S yy6 -589"/ CjC / CO#" <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building n-F Cac- / <br /> g n /e .�^ - ) HEAT SOURCE: <br /> Proposed Use of Building R e h t , C S:n J �e a^�• / ft Gas_X Electric—X Other_ <br /> Building type: _A 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): H cA <br /> C o n Q C r�t x : st i n 5 c l o s e t s i `� (•� a f-�-, w�'� <br /> otor ✓w% CI` ) re -roof <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: gNew_Addn XAlteration_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 /> j Gas piping Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> ! Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> j 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 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 /> Z44 It Z ,S Z C)/'/ <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />