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• 0 <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 /> r?1'4C( <br /> SITE ADDRESS: PROPERTY TAX# ^7 i PERMIT# <br /> -d• �/Y �(/�. ©O ..- Z � DGS /�� i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER '�IS 1S7- Phone/E-mail <br /> Address ] F City/State/Zip �� g <br /> APPLICANT:_Owner _Owner's Agent lr Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 1417 Lit �.' State Lic.#CAS< -P C1 6e)OIJ ity Bus. Lic.# <br /> Address 7/6,5' �,5-4Add- Phone/Email -23j—So2� <br /> TENANT BUSINESS NAME CONTACT-�OR PERMIT <br /> Z�1 ��5 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: -XS <br /> 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 OFWORK(additional space provided on the back): <br /> r <br /> . t <br /> � <br /> �¢ Ck �J-q f. <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 I Toilet <br /> I Forced air systems j Bathtub <br /> j Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range j Dishwasher <br /> Clothes dryer ; Clothes washer <br /> Range hood Water heater <br /> j Exhaust fan Sink(service/bar/mop/etc.) <br /> j 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 j Roof drains <br /> Other i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: 5�1- <br /> Number of Heads i 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 16.27 RCW and 296.200A WAC. <br /> Owner/ uthorized Agent Signature Date (Revised 3/2013) <br />