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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# PERMIT# <br /> / ,-G,sj 4 ' tri olla <br /> LEGAL for new construction:/Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNERLGA( /l^�►i( 0 Phone/E-mail <br /> Address �/$ Cry WeJ1coA.qty/State/Zip <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 ''1( Q� (�(r+��11 LC State Lic.# Z-l FQC L q6 ty Bus. Lic.# <br /> Address /�/ r Q �>L �j�_ &JA. / Phone/Email Zvi 7S-IG�Il o`We,.)-1Sf4%k coo- <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT.LSe l-_TG.Mccy-C> <br /> loE- 756- 671 t <br /> Phone/E-mail <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.1._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <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 /> j Forced air systems j Bathtub <br /> j Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range I Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood j Water heater <br /> j Exhaust fan j Sink(service/bar/mop/etc.) <br /> j Heat pump I Backflow preventer <br /> j Unit heater j Urinal <br /> j Boiler j Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove j Grease trap <br /> Ducting j Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 /> wit21am <br /> !aut !iibiy herein or not.Th Ing 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 of th' pro rty 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 /> �j /1/ <br /> Ow rze tgnature Date (Revised 3/2013) <br />