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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 /> �P2f7 y n9e4 ", 21c-—�;`/�'c /2-? <br /> SITE ADDRESS]j/27 /6° f/t g SL'V/27 PROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision 9 Lot No. (attach copy of long legal description) <br /> . OWNER t /7 74 #02,7A- OJ C6 /Z Phone/E-mail <br /> Address /09/1) 6r-, ) City/State/Zip cJi ,2 <br /> APPLICANT:_OwnerQwner'sAgentt, __Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR M dZi / 7&r/r/ c � i � State Lic.# Ce-44 /tl r 93DRlity Bus. Lic.# " <br /> Address /09/0 Egeo i r it �-( �a�� 712 Phone/Email 1/25---.....K-S-3-6--WV <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 72-0M 7SM 41z -239--5"J 75--- <br /> Phone/E-mail /t'6/4.ck r2 ce!) C -cC.S� • /V <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK V'-6"1'do'`a <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 OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING 1"-;iRMIT 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 /> NC—air handling units ; Toilet <br /> Forced air systems j Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I 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 f Drinking Fountain <br /> Refrigeration I Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas • <br /> SPRINKLER/ SUPPRESSION SYSTEM I 'Other:meek- fo E,45, • <br /> Number of Heads ' I Other: A'k4.— <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 /> Own r/Authorized Agent Signature Date (Revised 3/2013) <br />