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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# PE IT <br /> SITE ADDRESS: I <br /> LEGAL for new construction: Short Plat/subdivision tum ` N "S$L Lot No. (attach copy of long legal description) <br /> OWNER i-�t�U(k pf v��V� 4+ �es Phone/E-mai 41PfIr ( tti"'I <br /> Address392Z t`^ ,4�c. Aj Z City/State/Zip ,mUv S�% e .Z-7 C` <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 I (xck � ��5 t�tY�NJ State Lic.# WX(k k 13-T-Ol•N DZ-City Bus. Lic.#0532C <br /> Address q 2Z K T+�j A� &/E f T ck SVk ��/ Z �'S- L`)1 - 2 <br /> 4OC -K 2-`/ `- f <br /> I 1� Phone Email +%�I, , hQ(((I.c"0 -key f, (c-,A4 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> • 5�— J � <br /> c�� <br /> i Haut:k <br /> Phone/E-mail 5-&W,- Z-I Z C <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK :4 C <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 1QA (✓i :J S Gas h Electric_ Other_ <br /> Building type Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of ro ect: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> A 31 <br /> 'lit, 9,V3 15v L 0 c� 2- <br /> MECHANICAL <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:X—New_Addn _Alteration_Repair Type of Project: New_Add. _Alteration_Repair <br /> Show Number(#)of fixtures Show Number #)of Fixtures <br /> A/C-air handling units 3 Toilet <br /> Forced airs stems Bathtub <br /> GasPiPing 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 this type of work will be comps <br /> with wether specified herein or not.The gr riling 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 rued t o er t is pr a rform the work for which rapplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I <br /> Owne Aut rized Agent Sig t re Date (Revised 912014)hL 2 <br /> %1 <br />