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Tl v <br /> 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 /> VV 130 OW-2 <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> LpoS P0q01 l 1 , <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER PS-o Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:—Owner _Owner's Agent K Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR a ,, State Lic.# SIS ?2kI City Bus. Lic.# <br /> Address Phone/EmailC�s-76/ 3GyOWJ Cep <br /> TENANT BUSINESS NAME ` CONTACT FOR PERMIT <br /> v...». .C— 4•dw�G Srt <br /> evs Cel",v <br /> N,.y„G he Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKS tib© <br /> HEAT SOURCE: <br /> -E <br /> Existing Use of Building Res��,,�.ti 1 <br /> Proposed Use of Building Gas_ Electric -/ Other_ <br /> Building type: it, Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition A Remodel Repair_T.1._Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional spece provided on the back): R�t�-edlt �o1w.C Ada l be�romt..., <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 /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater 1 j Shower <br /> Gas fireplace ! i Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood a er hea <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> I Unit heater j 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 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 /> 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 /> b,� S-13-13 <br /> O er/Authorized Agent Signature Date (Revised 3/2013) <br />