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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# 7 PERMIT <br /> ZRO V-02 -y-a0 1403 -ol,5 <br /> LEGAL for new construction: Short Platt/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Fp-� �V+t)4—$Sio✓!q Phone/E-mail <br /> Addressfol X $2(a3 ( , City/State/Zip <br /> APPLICANT:—Owner _Own1er's Agent Contractor —contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> �� <br /> CONTRACTOR Yr , e-l( i.-_f.Ot,� / m State Lic.# / •/� City Bus. Lic. #01704i <br /> Address SZ<P , U/C�� #� �-(p Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ,0 <br /> Phone/E-mail /`/p Aq---)1,ZeV*'t. VhI— t— �•�•�t <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR &:, 4 <br /> Existing Use of Building J HEAT SOURCE: <br /> Proposed Use of Building e>, I Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family—ke' Commercial <br /> Type of project: New Addition _2c�Remodel Repair_T.I._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 /> Forced air systems ! Bathtub <br /> t Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> I Gas fireplace Kitchen sink&disposal <br /> I Gas range I Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood j Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I 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 j 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 y1terly 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/Aut orized Agent Signatur Date (Revised 3/2013) <br />