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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: � PROPERTY TAX # PERMIT # <br />� �7 � ���� � ��. ' L '"� �J � "' �� - <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � �j U � /rJ �j Phone/E-mail %� � 1/ T >� �%,�Jr �"'�' ,,%" cJ .� l�/� •�a,'rl/ <br />Address ,j G-�� � s��G� i'JL'% � � ' City/State/Zip „ � �� � � G' `%G/� 'C��� <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�5c Provide a ieiter or �on5enc rrom me owner �o do work �n me space� <br />CONTRACTOR k j^(1 � f Gi _�� C State Lic. #� K, � l�e'� �{� I��'��it�r s.�Lic. # <br />Address Phone/Email <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR � � <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 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 (additiona/ space provided on the back) : f> i � <br />� �,f/��� hQ ���� �C C� : J s'�>��� ��� ���C-' � �. � 1�u � P <br />J <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 />j Gas piping j Lavatory (wash basin) <br />� Water heater j Shower <br />Gas fireplace j 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 />i 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 j Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads i Other: <br />I hereby ceRify that I have read and examined this application and know lhe 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 olher state or local law regulating construction <br />That a horized by the ner 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 />� <br />. � ��� .� � % � 1 � <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />