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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIN KLER/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 />63a (o <br />SITE ADDRESS: <br />PROPERTY TAX # <br />LERMIT # <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 _ Owier's Agent _ Contractor _ Contractor's Agent _ Tenant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR �D?� �l*lv� `� mil- r s <br />State Lice( ## S614X:7 14)106) 7�4 j�fCity Bus. #D.J%O > O <br />/Lic. <br />Address % _ �c�t ��/v Phone/Email © 6,(73 1 <br />�y i • <br />TENANT BUSINESS NAME: <br />CONTACT FOR PERMIT <br />wf�.l�Yl.r Z i� %�7 �, <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 _ 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 />Y� L� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn —Alteration aRepair <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 fir place Kitchen sink & disposal <br />Gas range Dishwasher <br />Clothes dryer Clothes washer <br />Range hood Water heater <br />Exhaust fan j Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer (inside bldg) <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />I <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />I <br />Ducting <br />Roof drains <br />Other_ <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify t 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 />w hether ecified herein or not. The granting of a permi O;s not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />hat I�aFn a horized by the own of gZ,,It. <br />perfo the ork 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 412015) <br />A'D�bvo/J <br />