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��ERMI <br />T APPLICATIO <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />TE ADDRESS: PROPERTY TAX # IT # � =� <br />1100 Pacific Ave., Everett, WA 98201 ���Q� �(, �j <br />for new construction: Short Plat/subd <br />dress 1100 PaCifiC AVe <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />City/State/Zip Everett, WA 98201 <br />PPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor'S A92f1Y _ T2f1811t (must provide a letter of consent from the owner to do work in the space) <br />ONTRACTOR D.K. Systems, Inc. - DKSYSI*982L1 L& I Lic. # 030,428-00 COE Bus. Lic. #(1dQ7dd <br />PO Box 886. Burlinaton, WA 98233 <br />Everett Bone & Joint <br />BUILDING PERMIT APPLICATION <br />Pno�e�Emai� 360-755-1555 <br />R PERMIT Kevin Korthuis 360-770-7981 <br />kev i n@ d ksyste m s i n c. co m <br />NTRACT PRICE OF WORK $ S.00O.00 <br />Existing Use of Building Merlir.al A�Jministrati�n Rlcla � <br />Proposed Use of Building Medical Administration Bldg <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition Remodel Repair X T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />2nd & 3rd Floor Remodel - Modifing Supply Air Grille and Balancing. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn X Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air svstems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />INKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />_ Electric Other <br />molition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tra� <br />Medical Gas <br />Other: <br />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 propeRy to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />/� <br />y' � �, � <br />� � ��� � � �1 — ��� — A� <br />Owner/Authorizetl Agent Signature c Date <br />(Revised 6/2012) <br />