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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 />13 C�(o <br />SITE ADDRESS: <br />a � ` �s�b ram: �� <br />PROPERTY TAX # <br />PE IT # <br />-V <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address <br />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 �L) 7.�- <br />State Lic. # �O t� �N Uv � 7 jC City Bus. Lic. # d3 6 3c)' <br />,�-�-� <br />Address �7�%G� _ Phone/Email �1(� - ��v� ' % <br />TENANT BU51NES-5 NAME <br />CONTACT FOR PERMIT �, .� `S <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other_ <br />Building type: ,_ Single Family _ Duplex _Townhouse l Multi -Family _ Commercial <br />Type of project: _ New Addition _ Remodell:�-t-­Repair _ T.I. _ Sign _Sprinkler _Demolition_Change 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 Toilet <br />Forced air systems Bathtub <br />Gas piping 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 Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer (inside bldg) <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />Refrigeration Floor drain <br />Woodstove I Grease trap <br />I Ducting Roof drains <br />Other <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />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 permi es not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />Tha am orized by the owner of is pr to pert th work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />7- ors <br />Owner/Authorized Agent Signature Date (Revised 412015) <br />� ��a� �� mac`►- ��� <br />