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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: I PROPERTY TAX# Y39/I de/DD- /O/ PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of ring legal description) <br /> OWNER SXc-- 2 L- PRS mE 17`2o PER-1-JC G,lone/E-mail /14) <br /> Address r,6 p x City/State/Zip 3.17.-110-4-1--e-► (A✓ 0� -52-6 <br /> APPLICANT: _X Owner Owner's Agent Contractor _Contractors 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 ,s>/1-7)//e-- Phone/Email vS/Yr)J <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building P/ti' kritVL. L dr" de— m 3RLE HEAT SOURCE: <br /> Proposed Use of Building siqE=ve \ Z PA A-107- Gas Electric Other <br /> Building type: 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): <br /> -r- <br /> E/02 J p t -i►v 6(yi rLt, (el,LD -- P o i-i` y-L NQS g fC - _ - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Adds 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 air systems 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 I Grease trap <br /> Ducting Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 /> 0 <br /> Owner/ uthorized Agent Signature / Date (Revised 3/2013) <br />