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� <br />• <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 />A�DRESS: PROPERTY TAX # P.ERMIT # <br />I t�1 � 20 � . C�i�.� ►'Load <br />LEGAL for new construction: Short PlaUsubdivision <br />V g-(L e ow �u-r s /-1-SS � �"�'h o r� <br />OWNER L�o �p� p�-Sori �S �roornr�i't, M4v� <br />Address j�"J�31 NFi g� 5{' ',Sl.t.�'i� �U <br />APPLICANT: _ Owner �Owner's Agent _ Contractor _ <br />CONTRACTOR jN(GLGoG{ C.t9n S'FYu-�-'f1 <br />Address I I(�j /� ���� S�, JC4 <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �i?25. �`�7.59�0 / '��„r�,.��,���� <br />City/State/Zip <br />� <br />� O <br />COntfaCtOf�S A9enl _ TBnan� (must provide a ietter of consent from the owner to do work in the space) <br />LC L& I Lic. # yV� EOCLQ51 � COE Bus. Lic. # <br />�g, , Phone/Email 2�, 5�{$, %Qj�?7 <br />CONTACT FOR PERMIT �i� �� J Z[oNS� �{.,�,�}.S. <br />Phone/E-mail �1-`'�• 2`}i3. �7$2 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�Z3 I• y�_ <br />Existing Use of Building ,/�UGf/ e�%�`J�'J�LjiO' �i*",Y'l�E1V%:�'C HEAT SOURCE <br />Proposed Use of Building �� �E�f�'� G'o� Gas Electric <br />Building type: _ Single Family _ Duplex _Townhouse X' Multi-Family _ Commercial <br />Type of project: New Addition Remodel �Repair _ T.I. _ Sign _Sprinkler Demolition Chang� <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />��'. i��a,�% I s2 l/1� v<2. 1`C. /q' � O ✓.:i �'� /'C ..�i t�iF' �7'' R� <br />t� 3 �/ �r l r fYI � 4 T�- F�`a i�� �,E �'r�c��'f,�G crs�'r/�'er�1e <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />Gas firepl� <br />Gas ranqe <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Other <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />I Lavatorv (wash basin) <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Sink (service/bar/ <br />BackFlow preventi <br />Urinal <br />Drinkinq Fountain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby ceRify 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 Sta4e Contractors Law 1827 RCW and 296.200A WAC. <br />/ � 2�21� �3 <br />Owner Authorize Agent Sig ature Date (Revised 6/2012) <br />l�� <br />