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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 yywww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5 j?�; '��'' �'� ' b'Jj <br /> SITE ADDREtS: �z�� PROPERTY TAX# PERMIT# <br /> 2- U C P. e AA1 79ZQ� - O till <br /> LEGAL for new construction: Short <br /> tPlat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER � ;/ P� E'�/��•� <- Phone/E-mail %Z5 3ZZZ, <br /> Address �� qL! 1; D` City/State/Zip /Iv ) -ko I—L F <br /> AP PLICANT:_Owner _Owner's Agent Contractor _Contractor's Agent A/ Tenant(must provide <br /> a letter of consent from the owner to do work in the space) <br /> CONTRACTOR�n(�Ip ?� 5 --5 L& I Lic.#/�:���; IiL°r!Z/J_/ CJO�E Bus. Lic.#Q 5q 09 <br /> Address ti� �t��t �? (� LSJ� J Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �e. n J <br /> Phone/E-mail 7/31- f7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKO f �? r <br /> Existing Use of Building 1�yz{�byi HEAT SOURCE: <br /> Proposed Use of Building <br /> p g I�✓l�7� Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family -xCommercial <br /> Type of project: New Addition Remodel Repair T.1._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 /> I 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 /> E 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 I Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration i Floor drain <br /> Woodstove Grease trap <br /> Ducting I Roof drains <br /> Other j 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 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 /> 1-2- <br /> Owner/Auth d Agent Signat Date (Revised 6/2012) <br />