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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# PKRMIT# r t5' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of'Ong legal description) <br /> • <br /> OWNER 40tu,uc,, 0-.Pf__ Phone/E-mail "tZ5'3` l-(t;S (.4) <br /> Address s�3C Evl✓E6,Q£e- t lid`{ City/State/Zip �U� -k i vZZ <br /> APPLICANT: X Owner _Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR '—'----1 -1-,T- (--)l, N�L State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Tp'p 1Z .0-l-oc_k_ <br /> Phone/E-mail 1 Z' -791'(0S5-6,• /-t-bciff, lloce- -t (ivVe- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 44 p,o <br /> ccD <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas ElectricOther <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(additional space provided on the back): <br /> 'Iz-a1/4-s1AErlLL-_osL4. _ <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 /> Forced air systems Bathtub <br /> Gas piping 1 Lavatory(wash basin). <br /> Water heater I Shower • <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> I Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> I Ducting l Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM • <br /> 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 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 /> i.gw 08/zS/�� <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br /> • s !` <br />