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PERMIT APPLICATION <br />BUILDING/II�IECHANICAL/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,L.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM "�O ��iL <br />ADDRESS: � PROPERTY TAX # PERMIT # <br />���--�� � i Z� S�' ��-- � �.. � c��� � �Oc%r� �-{ v � t� c� i� �--�-c-t--� <br />EGAL for new construction: Short PlaUsubdivision <br />iWNER t�Z � �,� �I"E �/�L��R <br />Lot No. (attach copy of long legal description) <br />� �5--�IPhone/E-mail <br />ress City/State/Zip <br />�LICANT: _ Owner _ Owner's Agent � Contractor _ Contractor'S Ag@f1Y _ T@I1811Y (must provide a letter of consent from the owner to do work in the space) <br />NTRACTOR }� r I� � Q����,�.5�., 4` i(`�.- "�-t(;-�;p L& I Lic. #- j,�'�' �--�� ��' COE Bus. Lic. # <br />.K. �1� 7s�,G G <br />ress f (� L �, �.E� . v� ��, (,,,� � PhonelEmail � �C'�� � � <br />JANT BUSINESS NAME CONTACT FOR PERMIT <br />� 3 L.'t i � 1�. -� ;�*`-1��'1.� �2.-c�� S'l �?��� , <br />Phone/E-mail '� \ fST�,�, 'r�2��1 ��t �� � rkJ� m�`� �' G � M <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />CONTRACT PRICE OF WORK �. 3 bC� <br />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 (additiona� space provided on the back): <br />%J,[�� i`�i=��.o i,�e��.� t1�i C�r2c� Gz: ��� ���� ��i,s�� ��� �� <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i A�'C — air handling units <br />' Forced air systems <br />' Gas piping <br />' VVaterheater <br />Gas fireplace <br />Gas range <br />I Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />' Unit heater <br />Boiler <br />� Refriaeration <br />V1/oodstove <br />V lI1Cl <br />SPRINKLER / �UPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) of fixtures <br />Toilet <br />I Bathtub <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Medical Gas <br />Other: <br />Other: <br />I hereby certi(y that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be complied <br />with whether spec�ed 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 consiruction <br />That I am authorized b the owner of this property to perform ihe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />i � <br />, l — 2.�'�-- i. <br />OwnerlAuthorized Agent ignatur Date (Revised 6/2012) <br />I <br />