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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: PR P RTY TAX.I4 P I # <br /> 2.0 ►4 cc► cs - �vc.).Ec�e ti- [L[�9 tot OU - 3 `i -1-1-20 -661.06 Ce_(�2- <br /> LEGAL for new construction: Short Plat/subdivision j 1 V l.S i Cyd 1{ Pk 4Eo No. C (attach copy of long legal description) <br /> OWNER 0 , t R . '1- ,DCZtrte SA c Phone/E-mail 425 252. Ili- - <br /> Address 12, (5 pao< IDR , City/State/Zip `J�v-c Lull, �'32.63 <br /> / f 1 <br /> CONTRACTOR t ' 'C� 1ti`} )Ptv(OW L&I Lic.# -10(...t2nc. (-' ci/ L <br /> Address c (a5 Ti - cn 5 t- C. �u�(, t�1 1 Phone/Email s , .i43 tS- <br /> TENANT BUSINESS NAME 1 ) T CONTACT FOR PERMIT i�,_, re. Co:,,,i- ,. <br /> Pe V rYtc,__ (Ici ' Phone/E-mail e,\l Qh BuvAe�'s J`�'©' a 2.N _l <br /> 1 ../L <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK -$1'-J, 09 0L) <br /> Existing Use of Building 1 HEAT SOURCE: <br /> Proposed Use of Building `p 1-;.1a.L Cxr..ril e- Gas Electric Other <br /> Building type: X Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: X New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> Description of Work(additional� �o space provided on thetback)(: <br /> CGNc�TMC 1 i0v. e'r 1(0 SF d[�n cVlcd, po3 '"� ..10„,r- e <br /> Have you started working without a permit? YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type Project: _New_Addn Alteration_Repair Type o •roject: New Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)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 itchen sink&dispe al <br /> range Di- washer <br /> i . <br /> Clot'-s d •r Cloth- was •r <br /> Range '••od Water h-. er <br /> Exh..st fa Sink( - icc bar/mop/etc.) <br /> H:.t pump Ba low prey-.ter <br /> nit heater inal <br /> Boiler Drinking Fountain <br /> • RefrigerationFloor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> PRINKLER / SUPPRESSION SYSTE Other: <br /> Number of Heads Other: <br /> • <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 <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform the work for which application i a and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> 6/4/tZ <br /> Owner/A or' ed Agent Signature Date (Revised 2/2011) <br />