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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 /> SITE ADDRESS: PROPERTY TAX# PE IT# <br /> r <br /> a3 �o pr� 5'K u <br /> LEGAL for new construction: Short Plat/subdivision ,,POA <br /> No. (attach copy of long legal description) <br /> OWNER SL) -5�� dZ-k S;CU�"F POA Phone/E-mail <br /> C<� 4; <br /> Address �( pr s� City/State/Zip <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 Gtr f- 12" S I P�C13 4 State Lic.# > (3�7City Bus. Lic.# <br /> Address . 0, X yXL L i/)CJ"*kYJA 444 42`V l Phone/Email �'q22--S-21VJ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> (Wlszt Park - ��► cis ,�. �� t >r �,r--yzz s �s`" <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building L e- HEAT SOURCE: <br /> Proposed Use of Building 4 r Sir�-� «��L�er Gasx Electric_ Other <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family —Commercial <br /> Tvoe of project: NewAdditioni_Remodel Repair_T.I._Sign_Sprinkler_Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> FT <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ _ <br /> 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 air systems Bathtub <br /> j Gas piping ! Lavatory(wash basin) <br /> ! Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range Dishwasher <br /> ! Clothes dryer i Clothes washer <br /> Range hood Water heater <br /> Exhaust fan ! Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> ! Unit heater Urinal <br /> Boiler ! Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove ( Grease trap <br /> Ducting Roof drains <br /> j Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that ave 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 specifie 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 /> Xhat I am authorized the owner of t ' pr :e 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 3/2013) <br />