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• 0 <br /> 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS:- PROPERTYTAX# PE IT# <br /> 1 1:7,01-063 <br /> LEGAL for new construction: Short Plat(subdivision 41 �� 1�- Lot No. N(attach copy of long legal description) <br /> 1 1 <br /> OWNER �( f l� � �5 Phone/E-mail U7 <br /> Address(2 V k,N `i ' t('1 I 11NjJ City/State/Zip <br /> APPLICANT:—Owner St_Owners Agent —Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do Inthe ace) <br /> CONTRACTO�R7 J��,1VM( 0 0i'Vl lj��1( C LLC� �/} L&I Lic.# PcU V�}"��( pLf���I(,-S COE Bus. <br /> Vic.# <br /> Address t ,"Z V2\'( �vl )w , v )a){ t'0w( l `r L " Phone/Email G)iJ C l V <br /> TENAN AME CONTACT FOR <br /> /PERMIT }. <br /> Phone/E-mail "1 Ll ' M� t�✓ 100 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $p ?>'722 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other_ <br /> Building type: _Single Family _Duplexkl-sTownhouse _Multi-Family _Commercial <br /> Type of project: ` New _Addition _(Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRI PTIONt OF WORK(additional space providedon the back): <br /> S <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 /> ill 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 I am authorized by the owner of this property to perform the work forwhich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> y <br /> Owner/Aut_rized Agent Signature Date (Revised 6/2012) <br />