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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' ,- # PER IT#Zll /A/"t ,� ✓� IPROPERTY:TAXaPV <br /> 1 11 -0I; <br /> LEGAL for new construction: Short Plat/"subdivision Lot No. (attach copy of long legal description) <br /> OWNER66-14.7;e7/– /9Dc%/Ak; Air-ha/r-/ Phone/E-mail /2-3775-02- Z G 2-- <br /> Address �v 2X /J / / City/State/Zip z: 77/6.776-777Ai,/f7 ge39Z696 <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 (State Lic.# City Bus. Lic.# <br /> Address (Phone/Email <br /> TENANT BUSINESS NAME C 36/,C 3C _ CONTACT FOR PERMIT <br /> Phone/E-mail7-5.J n?:6;',5.61e, kohl/ C`Cly /1, cx_c• <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 9'd'2 . OD <br /> Existing Use of Building '� /‹. HEAT SOURCE:EA <br /> Proposed Use of Building Gas t/ 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 on the back): <br /> / <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 /> J 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 /> 7—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 a`f ori by t .wner 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 /> Owner/Auth,'fs•.Agent Signature Date <br /> v (Revised 9/2014) • <br />