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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: <br />LEGAL for new construction: hort PlaUsubdivision <br />� C <br />OWNER �y�/�/` <br />Address �Q ' � � / <br />APPLICANT: __ Owner � Owner's Agent _ Contractor <br />CONTRACTOR � l�i7 �/ L/��y7 ��lp <br />Address �il/%�%� /�%��"7�yr/�iiA�Ff�//� <br />� IPROPERTYTAXI/���%J7',�(/ I PK/Mll i��� O/� <br />Lot No. (attach copy of long legal description) <br />f, <br />/ ne/E-mail <br />City/State/Zip �,� � Q <br />COf1tf8C�0� 5 i�9Bf1� _ T8f18f1t (must provide a lefler of consent from ihe owner to do work in the space) <br />�j�7 State Lic. #�//%f/�/! �'!�/�sj�) City Bus. Lir�. # f%?j�j2'f� <br />'phone/Email <br />CONTACT F R PERMIT <br />i � <br />' ryl�ri�Qi Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building ,%� Ga <br />Building type: Single Famiiy _ Duplex _Townhouse _ Multi-Family � Commercial <br />T e of ro'ect: New Addition Remodel Re air T.I. Si n S rinkler <br />DESCRIPTION OF WORK (additional space provided on the back): `O,� �.�d` � <br />C���� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _._Alteration _Repair <br />Show Number (# of fixtures <br />� A/C — air handlin units <br />Forced air s stems <br />� Gas i in <br />� Water heater <br />Gas fireplace <br />HEAT SOURCE: <br />Electric_� Other <br />molifon Chan e of Use <br />%�'i✓i! � /`J✓il� <br />PLUMBING PERMIT APPLICATION <br />of Project: New Addn _ Alteration Repair <br />Show Number (#) of fixtures <br />Toilet <br />f Bathtub <br />j Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & dis o <br />Dishwasher <br />alothes washev' <br />� <br />aust fan I i k r�iice/bar/mo /etc. <br />eat um i f ow reventer <br />Unit heater rin I <br />Boiler � Drinkin Fountain <br />Refri eration ' i Floor drain <br />Woodstove , � Grease tra <br />i Ductin � Roof drains <br />Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM I other: <br />� Number of Heads i Other: <br />� <br />I hereby certi at 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 wheth 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, �ut�orized by the wner of this property to perform [he work for,ivhich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />" I�/ � <br />wner/Au orized Agent Signature / Date (Revised 9/2014) 1�� <br />�� <br />