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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS: ��_�''��� ; % � � _, PROPERTYTAX# PERMIT# <br />�� �--�'1 ��-� �%�' 2 - <br />LEGAL for new struction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER , �Z�;,���`/� �� , Phone/E-mail <br />. .� <br />Address �C'7C�� � �� ��� L�J City/State/Zip <br />APPLICANT: �lOwner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (musc Provide a iener ot consen� trom ir,e owner �o do wo� in tne space� <br />CONTRACTOR �' �/\I �j(� L& I Lic. # COE Bus. Lic. # <br />Address Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail 7� � ��v �' <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of�uilding Gas_ Electric_ Other <br />Building type: �� Single Family _ Duple� _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 />l��'�� - ��� � � � - <br />�, - , ; - . ,. � -- <br />/ <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 fixfures <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 Backflow preventer <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />Refrigeration Floor drain <br />Woodstove 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 complied <br />with whether specified herein or not. The g ranting of a permit does not presume to give authority to violate or cancel the provision o f any other state or local law regulating construction <br />That I am authorized b lhe_owner of this property to pertorm the work for which application is made and I comply with the State Contractors L aw 18.27 RCW and 296200A WAC. <br />r �.�`"�� � ;��y, <br />� ' �� <br />�`Owner/Authorized Agent Signature � � Date (Revised 6/2012) <br />