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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: �r/0 d ,, )��'q0fC A�J���/ JP I�)� PROPERTY TAX# PERMIT# _ <br /> LEGAL for new construction:(Short Plat/subdivision Lot No. (attach copy of long legal dlescription) <br /> OWNER LaLk rQ h Phone/E-mail. 365" jj '' '' <br /> Address V� [mr r-e ni City/State/Zip Eu� � wTef; u <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent <Tenant(must provide a letter of consent from the ownerto do work in the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 05,+ -7 (-5 <br /> AJ <br /> mail <br /> / <br /> C CA L'( 1 5U V`� ��f V'I�f:S LL Phone/E-mail �J '53 /- ISO (ISq& CXJJ' 5U <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building V _ ©( HEAT SOURCE: <br /> Proposed Use of Building Laundryc I ( 1 Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.I. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 1 fiv ug 0,F 11.E <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: X 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 airs stems j 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(inside bid <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 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 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 au?o' d � <br /> be ownerof this pr toperform the work for which application is made and I compty with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � ��.. V2— <br /> •fix`'/, yam_/ ' /'�K `�—/� 6 <br /> er/ uthorized Agent S atu a vL Date (Revised 4/2015) <br />