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� <br />. <br />PG(`IY1�� /`1r1—L'�/'-'� 1 ��� <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 />ADDRESS: <br />PROPERTY TAX #i <br /># <br />����� ��o� v � s 4 � � — � 7 `t- <br />LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />OWNER � ,.J , I c Phone/E-mail � ,-C��7�;' ��� C_ U '' yr��t• 1' '`�w <br />c <br />Address ���<JT '�j, r�Y, ,-� City/State/Zip �- �j:�, � "� <br />APPLICANT: �, Owner _ OwnePs Agent _ Contractor _ Contractor�S AgEflt _ TBflBflf (must provide a letter of consent from the owner to do wo�k in the space) <br />CONTRACTOR 6`1 f� � i.:-+�,v' State Lic. # City Bus. Lic. # <br />Address <br />SS NAME <br />BUILDING PERMIT APPLICAiIOf�l <br />Existing Use of Building �>�n <br />Proposed Use of Building <br />Building type: � Single Family _ Duplex ._Townhouse _ <br />Type of project: New Addition Remodel Repair <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />��,-�� <br />t r��� r <br />IPhone/Email <br />ACT FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Multi-Family _ Commercial <br />T.I. Sign Sprinkler <br />HEAT SOURCE: <br />molition Chanqe of Use <br />_ <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 j Shower <br />Gas fireplace j Kitchen sink & disposal <br />j Gas range j Dishwasher <br />i Clothes dryer I Clothes washer <br />Range hood ; Water heater <br />� Exhaust fan � Sink (service/bar/mop/etc.) <br />� Heat pump i Backflow preventer <br />i Unit heater j Urinal <br />; Boiler Drinking Fountain <br />j Refrigeration j Floor drain <br />Woodstove ; Grease trap <br />Ducting i 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 periorm the work for which application is made and I comply with the State Contractors Law 18 27 RCW and 296.200A WAC. <br />����� �� � .�1��� <br />Owner/Authorized�lgent Signature Date (Revised 3/2013) <br />