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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 /> �i rl Et ► Av't C� 'Syy '71)en ( .l L � i I <br /> LEGAL for new construction: Short Plat/subdivision 1,..1.41 /'f jie{'/L(1l _Lot No Ef q (attach copy of long legal description) <br /> OWNER �Pifi�' RO ACttiK� Phone/E-mail 4 353-62) <br /> Address ��� .4 ft Mi e h r t A-‘)€- City/State/Zip EJ e jtt 1 1 ) 8 1�3 <br /> CONTRACTOR c%i�l-)nE(- L& I Lic.# V" <br /> Address a rne> Phone/Email <br /> TENANT BUSINESS NAME C NTACT FOR PERMI , <br /> -1 R1:4 K L (co evk i r� 4f-?S Z, <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 1 1cAie, Ire-'4.ci'e HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: )( Single 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): n , <br /> Have you started working without a permit? YES X NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New )(Add') Alteration Repair Type of Project: New Adds Alteration_Repair <br /> Show Number(8)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units ' r I Toilet <br /> Forced air systems Bathtub <br /> Gas piping Y l i 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 I Water heater <br /> 1 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> R I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM 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 <br /> this type of work wit 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 is made and I comply ith the State Contractors Law 18.27 RCW and 296.200 WAC <br /> 2/2 <br /> Owrfer/Authorized Agent Signature J Date (Revised 2/2011) (/2 <br />