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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 /> 112 J- M: tN� Vi0,) -Pil '�lo`� `_�c.'� (wou'3ol��u <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT: Owner Owner's Agent /<Contractor Contractor's Agent Tenant u„ust provide a letter or consent rre(T,the ovmer to do work IN the space) <br /> CONTRACTOR &I State Lic.# 61515Y5 *069 RS City Bus. Lic.#OL2(k <br /> ­ <br /> Address -4Zr72 NL k74;t` SY 4laNMoa.0 , VA 4'9026 Phone/Email 142,;- -4oZ--65p,� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �A� 7h 16A(A' ( (Z-((— Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK U U <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family X, Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 1711`�vSE-12-`�f AP D N£� DIFF✓SCK r ,�t -T-0 <br /> -�,�.}-,-�:,_ mel��,,�• �,y��r� - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New `C 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 /> 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 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 am authorized 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. <br /> Owner orize ent S ature Date <br /> (Revised 9/2014) <br />