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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: L „ • PROPERTY TAXOt— <br /> G--/9MT I AVE / /7 j� Li PERMIT se <br /> 9 00g <br /> LEGAL for new construction: Short Plat/subdivision f' �/�/L/ottN'o. (attach copy of long legal description) <br /> OWN EI2'G tki.3a2.14 ACP\ Phone/E-mail /- <br /> Address 7� I L G O.IA)-Y c/,City/State/Zip � "v w2,2_4_51 ( <br /> APPLICANT: Owner Owner's Agent Contractor ✓Contractor's Agent Tenant(must provide a letter of�consent Gtfrom the owner to do work in the space) <br /> CONTRACTOR lR,(,,A(7 1' Vl at,i4 binwe LL/State Lic.#C f 71—TU L(Z7 L. City Bus. Lic.#0E00 C) <br /> Address lA Phone/Email '7 /ILLC /„./U (.,6 <br /> TENANT BUSINESS NAME CONTACT FOR PERMI —l_ <br /> T33� (cti—c1/4/60 <br /> Phone/E-mail PfD. 17e6( /-&-T7-1 s c"-64/1/ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK__ I c2, cf <br /> Existing Use of Building • :Ir— t HEAT SOURCE:/ <br /> Proposed Use of Building ID v FL GasElectric_ 1/ other _ <br /> Building type: _ Single Family Duplex V 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 /> Y �u FL-EX ^-1:27a-/6.k) <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 /> NC—air handling units i Toilet <br /> Forced air systems Bathtub <br /> Gas piping 2— Lavatory(wash basin) <br /> I Water heater 1 Shower <br /> Gas fireplace fj Kitchen sink&disposal <br /> Gas range 1. Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> 5 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 I am e by e owner of is property to perform the w or which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC./ <br /> Owrt1 Authorized Agent Signature Date (Revised 4/2015) / <br />