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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# PERMIT# <br /> 4q3q Z 7 Atl LVOZET- q -zo3 /3 J ►6 6— O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER i3zi L % Phone/E-mail (4'Z5— Z'1 - G y92_ <br /> Address "63y 2 '1 p t/C w City/State/Zip s ZG 3 <br /> CONTRACTOR [4o0-&t o( f& L&I Lic.# <br /> Address t 612 SZ,fr� 57— 5e hio i ao 90 7 2_ Phone/Email 1425— l Yl- g7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT So t-C <br /> Q <br /> Phone/E-mail L(?, —9V-7 617 14c0.16-wo(L[L S ert i/ce� c <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed 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 on the back): <br /> CpSTRtvA-cT (/4-K( C� �c �a� �eV5 5'(TL <br /> Have you started working without a permit? YES Y.NO <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 I 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 <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any o er state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform t wor or which application is made and I comply <br /> with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> Vg/ <br /> (wner/Authorized Agent Signature Date (Revised 2/2011) <br />