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0 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 /> SITE ADDRESS: C7� SE PROPERTY TAX# IPERMIT# <br /> VV v <br /> LEGAL for new <br /> /I construction: Short Plat/subdivision Lot No. (attach copy of long <br /> legal description) <br /> OWNER V�� ►Y�Ci Phone/E-mail g ,l ✓`vZJ ` 2 '"1 0 <br /> Address q,2--1 City/State/Zip A $2-O'�) <br /> APPLICANT:—Owner Owner's Agent XContractor Contractor's Agent p_Tenant(must provide a letter <br /> �o'f)consent from the owner to do work in the space) <br /> CONTRACTOR ��r 1 t Vl State Lic. #P-W r ff0�13 City Bus. Lic. # <br /> Address 6�Q �/� ��S� I 0� �rDLI ,� 3 Phone/Email � --� 1 1 113 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> V/e4 i 161VIA AAA's t Z <br /> Phone/E-mail )--i l, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK-$ 21 �� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Useof wilding Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <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 k 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 Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow preventer inside bldg) <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove j Grease trap <br /> Ducting 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 comp <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,4 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 /> T2-1 ! C-// v� <br /> Owner/Authorized Agent Signature Date \ Vl gffevised 4/2015) <br />