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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: r PROPERTY TAX# 1. PERMI� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER r? L/ lfl ��r%�i Phone/E-mail 3 / f — / <br /> Address City/State/Zip / f �fio C�`Z' <br /> � £' /k,/4 <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 f � ��� i L&I Lic.#t A y/ 1,� 51 COE Bus. Lic.#01I <br /> rf � <br /> Address JW ��j+ �r t-J l)r Phone/Email �!e{� 1,j i vv <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> � Phone/Phone/ mail <br /> BUILDING PERMIT APPLICATIOO,NN CONTRACT PRICE OF WORK <br /> Existing Use of Building /d'�/ / HEAT SOURCE: <br /> Proposed Use of Building �Wt Y�hbl� � 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 WO K(additional pace provided on the back): <br /> lie <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 I Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood j Water heater <br /> j Exhaust fan Sink(service/bar/mop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler E Drinking Fountain <br /> j <br /> Refrigeration I Floor drain <br /> I Woodstove Grease trap <br /> Ducting Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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'Fielrin 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 th 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 /> Owner/Authorized Agent Signature Date (Revised 6/2012) ` <br /> `CLr' <br />