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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> /830 fa, 7rev S C10 71a 3nnp) C.-f I_ OO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER /d 12 hSAD �,� Phone/E-mail 25-25-0 3 ecoC AS <br /> C.,.. 7cd &!,"a t.Ly.17 <br /> Addressg- o fJ j «��,�- s City/State/Zip <br /> APPLICANT:A.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 b(,V errr j,, L&1 Lic.# COE Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK `120,OQO <br /> Existing Use of Building 14*- ! '' 4 f HEAT SOURCE: <br /> Proposed Use of Building jezd<; ,� ��� / SL Gas_ Electric Other <br /> Building type: 'Single Family Duplex Townhouse Multi-Family ^Commercial <br /> Type of project: New Addition 474-Remodel Repair T.I. Sign Sprinkler_ Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> e�L <br /> fl LI C'Y / s°i /bee 2°'e/ / 0,1 e Ir-?"Iv �i f.";�9c� cS—/� CG.l✓ , <br /> ais rte' t' <br /> acs / 7/G 0,14 �1?s e'n � ��/6s, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New` Addn ,Alteration Repair Type of Project: _New iCAddn Alteration_Repair <br /> Show Number(#)of fixtures Show Nu ber(#)of fixtures <br /> NC-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 <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 <br /> Other: <br /> 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 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 which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> [2— <br /> Owner/ utho d Agent Signature 4( Date (Revised 6/2012) <br />