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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 /> PROPERTY TAX;`lR ( -CO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER DI,° .t':,( C l~ `iia k1ll itPhone/E-mail ` t:..' '� �-7 f ?fes`"'/ <br /> Address `4 I; ry\c - 1 _i e: ,;,,, .-: r "� etr,ri' 8V1`l b n lit F --t�t 1 C_.3 L <br /> 1 �, -� f. y GitylState2ip c <br /> APPLICANT:_Owner _Owner's Agent X_Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 1-L; •- k _ EtA 3 ..71ry1 :: rf.. LState Lic.#( 109-1-1-7 -5-3°D... City Bus.Lic.# 4/ <br /> Address C IC; �f �!lSR � ��" �, + j ("L.'l0L) Phone/Emai t:�'fJ� � " �-` t ja 0) )k a ~Prvi <br /> /... <br /> TENANT BUSINESS NAME J CONTACT FOR PERMI <br /> Phone/E-mail L 9-c.3 )-- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK jc5 'r~)'"— <br /> Existing Use of Building -?!Yt CV\f k -21-t ,v c i t 1k,L HEAT SOURCE: <br /> Proposed Use of Building t e t t l Gas Electric 1 , Other <br /> Building type: Single Family` Duplex Townhouse T Multi-Family Commercial <br /> Type of project: e New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provideOn the back): <br /> VY\AD\ -i- ' ---C_eip c? 's---- `\ uk,imbi oC <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 unitsToilet <br /> Forced air systems Bathtub WO <br /> Gas piping Lavatory(wash basin) <br /> Water heater i Shower <br /> Gas fireplace k Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer 1 i 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 I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove (' Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: -4(a 5 <br /> I 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 notpresume to give,authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am author' the owner of this property to perform ie work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> J g thorized Agent-Signature Date (Revised 9/2014) <br />