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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# PERMIT# <br /> t r /7 ( r l Sf A✓i%-k. Sn11-00I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 6,/1.17,-,-,4, .?/cp r/4 Phone/E-mail Z 4.4.- - 5 7 K- 7,-/- <br /> 7 <br /> Address /y 7 2 5- 4/6.--- 2 c '.-1 51 City/State/Zip ee//6�,,,,✓t, ('V/- 7rC%. 7 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR e/c c f/ 5-7e/G f' .,_ State Lic.#&S6SC OC/0 0 f City Bus. Lic.# 0 5JO< <br /> Address 2//a y 7O rr /7'✓1 '✓, ecii.1 /di. (•{/j¢ Phone/Email Yljj• 77s--- 2.10 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> l7w 7' /[�--5 re// <br /> �V 7-z>'I I`// 47 1 �''�f'�1/ 1s: Phone/E-mail L/Z r 7 7 r- —7�/c' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Al' ct%C , <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other_ <br /> Building type: —Single Family —Duplex_Townhouse —Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair—T.I.—Sign-r Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> iv\ 11 nn(YtivrvItv i— ()or <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 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/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove 1 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 by the owner of this property tothe work for which appr tion I made and I comply with the State Contractors Law 18.27 RCW and 298.200 AC. <br /> ipedorm <br /> 4 li ti. f..----' <br /> Owner/Aunorii�d Ag rfnDa S (Revised9/2 14 <br /> SJ Signature 0 ) (C <br />