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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 /> SITE ADDRE S' \( PROPERTY TAX# PE MI <br /> �� <br /> LEGAL for new construction: Short Plat/subdivision \�nA Lot No.‘"-°‘-(attach copy of longlegal description) <br /> OWNER ‘\--70 \-2/\60.\ L 1-4 <br /> t Phone/E-mail A S' t k 3pp - `gl�t y <br /> Address ,'Vik D1 brb W \j-eVQ,\17\- tate/Zip —!/v'R.‘r-C. " uv` 1 S\9 Z,; <br /> APPLICANT:_`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 \� \---CCa€A ��, \MAN(/' tate Lic.# E q , `3(PCity Bus. Lic.# 3.7 35 <br /> Address 1 ( QU (\ F y\k '\``wn /33 Phone/Email ' <br /> lib—C-A b 3- ` (DU <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �..- e7rO '(/ <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> e!of/ <br /> Building typSingle 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 /> \NL\N) Com,% \�o \ `\(. . QR(‘0\ --v <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT 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 /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range 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 /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify hat 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-:.ecified 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 /> T -t I a au ••ized •• •_-"y 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 /> fl1 <br /> Iv <br /> Owner/A 4 thori\d Agen 4 4 ature Date (Revised 9/2014) <br />