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� • <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: ' PROPERTY TAX# IT <br /> ��� � �(; � � 1 J� — � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �, Phone/E-mail <br /> Address �� C �� City/State/Zip � � •} � � <br /> APPLICANT:_Owner _Owner�S AgBflt ^ Of1t�8CtOf _COf7tfaCtO��S Ag2f11 _T2f1a�t(must provide a letter of consent from the owner to do work in ihe space) <br /> CONTRACTOR '` ��� L&I Lic.# ''��E � COE Bus. Lic. # � � <br /> Address r ���'' S� � � � � r�� Phone/Email (' ��`�(—���,� <br /> TENANT BUSINESS NAME CONTACT FQR P�MIT ���_/` ,t,� <br /> �� �f'IU.v111��, �,l�iu) �G <br /> Phone/E-mail � ��\f ' '�t"� /�/� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Ga Electric Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Si n Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(a itional space provided on the back): <br /> �e�.� , S ��r���- <br /> � <br /> � �� � .� _ �1 (D�� P�1Z/� C�� T� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: +�ew_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 pipin Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran e 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 /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> � Other 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 trua and correct.All provisions oi laws and ordinancAs 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 y the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br /> / - - �- � P <br /> . Z <br /> Owner/A orized Agent Signature Date (Revised 6/2012J <br />