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: 'ERIlIiIT APPL.ICATI� � . <br /> Bl11LDING/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: � � � r-� � � i V-` l'^�t�a PROPERTY TAX# �RMIT# ,� <br /> � � _ C�> '�%� � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER �-Gi���-�.� �-���—��� Phone/E-mail <br /> Address � L� 4 �,L-j �� �j f City(State/Zip �4jt��_ �(,� ���� � <br /> APPLICANT: r Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(mu5t provida a iener of consani rrom�ne owner to dp work in the spa�e) <br /> CONTRACTOR - U ���' �`, ��-�`7( :. State Lic.#�.�(� ��S�1.6�'`7n y Bus. Lic. #(„�"jU�G� <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE; <br /> Pfoposed 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 the back): � <br /> ��r��- 1'7 1�1�n ��" �:?���� ��L,i--� �f���.�,�" <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 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 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(inside bldg) <br /> Unit heater Urinal <br /> � Boiler Drinking Fountain <br /> ! Refrigeration Floor drain <br /> � Woodstove � Grease trap <br /> I 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 granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating conslruction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r,. <br /> �� � L��:��'� �' ?"' � `� <br /> OwnerlAuthorized Agent Signature Date (Revised 4/2015) <br />