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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 />SITE ADDRESS: � . , _. PROPERTY TAX #
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<br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br />OWNER °4� �- '' -` r.'' � � �
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<br />APPLICANT: _ Owner _ Owner's Agent F' COnVactor _ Contractofs Agent _ Tenant 1mus� provide a �etter of consent rrom the oNmer to c10 work in the space)
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<br />CONTRACTOR fr.'i i`' F���.��i�1;, ,:, i(i ����.�f� � i,���, L& I Lic. #*-��� 1",iV �t ��� � j;�� �; L'`lt���' � COE BuS. LiC. # Q�ij,7��_
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<br />TENANT BUSINESS NAME CONTACT FOR PERMIT —�' t�
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<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �,� J�G'l' �. C�(;
<br />Existing Use of Building il r � c�„ � HEAT SOURCE:
<br />Proposed Use of Building �l i�",. 1 Gas .�"+� E�ectric Other
<br />Building type: _ Single Famiiy _ Duplex _Townhouse _ Multi-Family .�'i 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 bacl<) :��,J r y�, �,; ?� .,I� -_� � y, �� ,;���.j �� ���; r„ f:,l� -�� l t��� .�� (- �.��r �
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<br />MECHANICAL PERMIT APPLICATION
<br />Type of Project; _New_Addn `, Alteration _Repair
<br />Show Number (#) of fixtures
<br />A/C — air handling units
<br />Forced air systems
<br />i Gas piping
<br />Water heater
<br />Gas fireplace
<br />' Gas range
<br />Clothes dryer
<br />Range hood
<br />Exhaust fan
<br />PLUMBING PERMIT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair
<br />Show Number (#J of fixtures
<br />Toilet
<br />Bathtub
<br />Lavatory (wash basin)
<br />Shower
<br />Kitchen sink & disposal
<br />Dishwasher
<br />Clothes washer
<br />Water heater
<br />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 />0 Ducting Roof drains
<br />Other Medical Gas
<br />SPRINKLER / SUPPRESSION SYSTEM ' Other.
<br />Number of Heads Other:
<br />I hereby certify (hal I have read and examined this applicalion and kno�•i the same to be true and correct. All prowsions o( laws and ordinances governing Ihis type of work will be complied
<br />with whether specified herein or noL The granting of a pernul does no� presume �o groe aulhonry to violate or cancel the provision of any other state or local law regulating construction
<br />That I am authorized by the owner of this property to perform the �•rork for which application is made and I comply with the Slate Contractors Law t 827 RCW and 296200A WAC.
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<br />Ow er/Au�horized Agent Signature Date (Revised 6/2012)
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