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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLIIFION <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 /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision 0 N cin Lot No.C47+(attach copy of long legal description) <br /> (P ff ,I _. <br /> OWNER � • VC tQ lC �WVVQ Phone/E-mail 4{ 25 1(AC)J ��j1) D <br /> Address 11)sw t4vgttM1�1 w0i M * foo City/State/Zip Qx uk 01 Z0+ <br /> APPLICANT:_Owner _Owners Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dow in the space) \. <br /> CONTRACTOR Mo.VVA <br /> ytuylPt ��(�' .a G p `+L&II Lic..# ADVfl t�k V LA C-1 L"S COE{Bust.. Lic # <br /> Address 5�Fi ��� 1 `) � ��- J �' 1���11�� -I I U(1, Phone/Email � �:y �j� �V <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 4-2-r, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family _Commercial <br /> Type of project: New _Addition _Remodel _Repair_T.I. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION DF WORK(additional space provided on the back): <br /> 1� � �� I�� �i <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 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 <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 Other: <br /> �.L. I 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 <br /> 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 /> Owner/Authorized Agent Signature Date (Revised 6/2012) i/,�, <br /> 'L <br />