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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 A PRE77M <br /> SS r_ 1 -r/ PROPERTY TAX H I D 1� _U <br /> qL <br /> LEGAL for new construction: Short Plat/subdivision Lot No. attach copy of luny legal descri tib <br /> OWNER `{-\Q Phone/E-mall <br /> Address �� �tiY _ r r�.;� City/State/zip , I JP <br /> APPLICANT:—Owner _Owner's Agont X-Contractor —Contractor's Agent _Tenant(must provide a lotior or consent from the ovmerto do work In the space) <br /> CONTRACTOR Lp&II Lic.# � L C^^OE Bus.Lic.#[�{,j qg 5 <br /> Address k � V\ Phone/Email �5-"AiA�k0(,0J <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �Yy ,.0L �.a OLW4 -ir <br /> ID��SONS Ph on e/E Ph53.-mail <br /> w 5 "(gt",. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building l T i I:_t _ HEAT SOURCE: <br /> Proposed Use of Buildings Gas,_�,, Electric_ Other_ <br /> Building type: _Single Family _Duplex—Townhouse _Multi-Family 2L Commercial <br /> Type of project: _New _Addition Remodel Repair . " T.I. Sign____Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(addriionai,pace provided on the back): <br /> nf <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Typo 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 /> Refriqeration 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 complied <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 stale or local law regulating construction <br /> That I am outt oriind 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.lwt1'erPAu fiorixod Agent Signature Date (Revised 6/2012) <br /> �c <br />