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�ERMIT APPLICAT <br /> O* <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: PROPERTY TAX# PERMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ,4l&Y' U0 F L6 Phone/E-mail <br /> Address 7 !b GaLZYJP- City/State/Zip 52-0/ <br /> APPLICANT:K Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINIF-56 NAME CONTACT FOR PERMIT /l ` _- <br /> LAI <br /> 4�'zc--W ,A PM( Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r->I,T(� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Bu! type: _Single Family _Duplex Townhouse —Multi-Family Commercial <br /> ype of project: _New on _�odel —Repair -T I. Sign_Sprinkler_Demolition ange of Use <br /> DESCRIPTION OF WORK(additiona pace provided on the back): W1 1I Lev",re R J)X <br /> �L <br /> $Lc—L.DG T ' X 6�T b dJEt k 7 1� ��a{� � "' `► G© Y .S LD i- i�'-0AQbdl dT -S�E OP. r /LP n o4 P60 <br /> MECHANI L PERMIT 1 PL N <br /> 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 i Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater ! Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan j Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> ! Refrigeration Floor drain <br /> Woodstove ! Grease trap <br /> ! Ducting Roof drains <br /> Other i 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 /> S Ig I,S <br /> Owner/Authorized Agent Signature Owe (Revised 4/2015) <br />