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• <br /> ERMIT APPLI � TION <br /> BUILDING/MECHANICAL/PLUMBIN /SIGN/ �PRINKL�R/DEMOLITION <br /> CITY OF EVERETT PER VICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: � � � � PROPERTY TAX# P MIT <br /> 1 ZO ' � �%�e /', �� '�'�s�, - � �„ <br /> � SC � �� ������y z �-�I I��'�-DD� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy oi`long legal description) <br /> OWNER ,;�C',/'�-� a (� � �--LC Phone/E-mail <br /> Address �ZG 3 ` �-u�fi'-i� �1"l r ��' CitylState/Zip �(�'�� V�/�� l� ` <br /> APPLICANT:_Owner _Owner's Agent ' Contractor _Contractor�5 Ag9tlt _T@Ilaf1Y(must provide a lette�r of consent from the owner to do work in ihe space) <br /> CONTRACTOR 5� , � '�< State Lic.# , �(/h( "L�}Z� j�l� City Bus. Lic.#�:�f�,3 -�y <br /> Address � ���� ��t �W � � Phone/Email��3` /�' �j�JU�� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ' <br /> �-�"�- x��^�' �`�� I <br /> �" �� Phone/E-mail �5'�'q��'� ��� y 5� e,v,��xhv��✓ + / <br /> H <br /> BU/LD/NG PERM/T APPLICAT/ON CONTRACT PRICE OF WORK �- :J :; <br /> jExisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Buiiding type: _Single Family _Duplex_Townhouse _Multi-Family �,Commercial <br /> T e of ro'ect; New Addition Remodel Re air T.I. � Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ��s"�����`�'�U� ��- X� 41� � ( S','��� <br /> G. ;-� w� lc s�ShS <br /> MECHANICAL PERMIT APPLICAT/ON PLUMB/NG PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn __Atteration_Repair <br /> Show Number #)of�xtures Show Number # of,Fixtures <br /> AIC-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavatory(wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes w.asher <br /> Ran e hood Water hes�ter <br /> Exhaust fan Sink(service/bar/mo /etc. <br /> Heat um Backflow��reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tri <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I 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 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 regulatlng construction <br /> That I am authorized by the own r of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> i <br /> ��, � � ��Z���� <br /> Owner/Authorized Agent Signature �� Date (Revised 9/2014)�/� <br /> � <br />