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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 /> SITE ADDRESS: PROPERTY TAX it PERMIT# <br /> 7 <br /> v5-44% S+ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 67lia3.6„,,‘ ( y� Phone/E-mail 4'ZS- �Gv,-1 <br /> Address 2_t\l S 34 s-1 City/State/Zip L`i UC..te.{-+ L./,4 CY2,3 j <br /> APPLICANT: Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR A\\t1 k � a4 / (46 r State Lic.# LL 7o p H504Q {-t City Bus. Lic.#0/156C, <br /> 2- <br /> Address 33 Z S� Phone/Email -2-Z-7 <br /> -��K� t+ Qu�, wk. _ (1,3 L t Ps , - - /elk <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT f,„ Lc , 42 -, <br /> Phone/E-mail Lifv,, L, tt 0a�n4 hc4��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4'5 �' <br /> Existing Use of Building R-e-5Id) HEAT SOURCE: <br /> Proposed Use of Building GasElectric 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 on the back): <br /> 12_e-ip(a"..--e--- d` 4-5 t n 5�-�- <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 <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 comp <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 construction <br /> That l 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 /> 47 <br /> Owner/Authorized Agent Signature °Date ` U Q 0 (Revised 9/2014) <br /> 44, (CJ • O <br />