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OPERMIT APPLICATIO <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 /> 2, <br /> Sw � rT vt t U) <br /> SITE ADDRESS: PZSrqPROPERTY TAX# PEM <br /> \/\/,4- <br /> # <br /> 'L. L Y2D UG'I GO G07) <br /> C, 0 C1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> AddressF3'2--'2— City/State/Zip w +-H. VU <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 VAI �j State Lic. # City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail h of toi I?U r 0{ r loto vA <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 123, <br /> Existing Use of Building \44 C/�Ilj—I HEAT SOURCE: <br /> Proposed Use of Building N,/',A, <br /> Gas Electric Other <br /> Building type: _Single Family Duplex_Townhouse Multi-Family "{Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler \XDemolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):-T-14V 5CDF7�i <br /> DE M nL l T1 O N 0 )<J-< <br /> TI N DZ►\J.F�-`rH-121) ISL 4N DS, VqI f.1 DG V, <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 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 comp <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 perforin the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC \ <br /> I0.2- <br /> Owner/Authorized gent Signature Date (Revised 4/2015) <br />