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ERMIT 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 # P MI # <br />� �l � - 0� <br />� ,' i / j , i� 5 � � „�.�. '�� l �' �%f `/ �� 'j �'r l! � .� � - C r D r a .,� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER 5�:1't�'.,✓ %��ct�°� �C � /< �� Phone/E-mail �-��`�� �� `f� �j� �l;t <br />/� ,-, <br />Address E�%� ,J�� .i' �f -� �� S~ City/State/Zip 5��� ��1� L-t�°� �� ��=� <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor'S A92f1Y _ T0I18111 (must provide a letter of consenl from lhe owner to do work in the space) <br />CONTRACTOR 1,. ,,, .�- ; .- ��;,�,� �/•;/� :: ;,� � State �ic. # v� � � 1�� ; ' " � �- C City Bus. Lic. # G� � t'.r( � 1 � <br />'� �J � 1 r � r� � y � �� _. �+ <br />- �7r9- ��� yS.. <br />Address J, C � � j� � j �`f�,'Yv � 1V k � ��..< �-"c'= �„✓..' �% � � �/ � Pf10112/Efll81� - <•.✓Q( l-�� �C_�Cd rJ��I'clC�'C"i �C-,k/ <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />`.�i �t l� ��--'�r�; �_-�/�. <br />��� o,��� <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building � i c✓�/ ��� �� �i �/ HEAT SOURCE: <br />� : <br />Proposed Use of Building 7,--=�;'�� �eGb�� Gas �` Electric Other <br />-� <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />T e of ro ect: New Addition � Remodel Re air T.I. Si n S rinkler Demolition Chan of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : �q �,ic1� � y� �� �,e- (� `�` c"� <br />E, � �J � �`�' S� r• � � � � � �, � � � = <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 fixiures <br />A/C — air handlin units � Toilet <br />Forced air s stems I Bathtub <br />E Gas i in Lavator wash basin <br />Water heater Shower <br />Gas fire lace Kitchen sink & dis osal <br />i Gas ran e i Dishwasher <br />Clothes d er Clothes washer <br />Ran e hood ; Water heater <br />Exhaust fan i Sink service/bar/mo /etc. <br />Heat um i Backflow reventer inside bid <br />i Unit heater ' Urinal <br />Boiler i Drinkin Fountain <br />Refri eration , Floor drain <br />Woodstove Grease tra <br />Ductin Roof drains <br />' Other Medical Gas <br />� <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 goveming this type of work will be comp <br />with whether specified herein or not. The granting of a permit does not presume to give authoMy to violate or cancel the provision of any other state or local law regulating construction <br />That I am au� rized by the owp�= of this property to pertorm the work fo hich a lication is made and om with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />/ � <br />,= � ;,,�/��� �� � � _ ��- �1=- --� -� --�' �-r� ;�'� � <br />� ,_ _. <br />wne Aut j ized Agent Signature Date � (Revised 4/2015) <br />r/� <br />