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���Rnni-r A���.�c�►-ri�1 <br />BUILDING/MECHAIVICAL/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 />= ADDRESS• <br />� �a3 r �,�,�Pr �-�� , ����PTiN�� �8 <br />�AL for new construction: Short PlaUsubdivision <br />NER ��,_L �f ��r' i hj Gt i <br />ess �C: Y,.7 a 1� �b L� -- -- <br />'LICANT: _ Owner � Owner's Agent _ Contractor _ <br />R <br />Address <br />� <br />C ✓��� �� uh I� 6� �- � ���' <br />BUILDING PERMIT APPLICATION <br />� i IPR�CY� I#ti� 1 c� ��o� ��I ��c�—��2-- <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail ��C "l l G� , ih5��l �G� CZ ��" ��''_ <br />City/State/Zip r— V eft' I� VV �� ���v% <br />COflifaCtOf�S A9Bfll _ TBflBflt (must provide a letfer of consent from the owner to dp work in the space) <br />State Lic. # <br />Phone/Email <br />CItV SUS. �IC. # <br />C:UN A[:I F'qV�K� YtKMII �.� (�'�L�; �/S <br />/� �, � n,� W i I�,� )� ` <br />Phone/E-mail %% "Y y�--G�� (/�/� �� j%T 7�f e�%6% ��° w�- <br />CONTRACT PRICE OF WORK ��`CC%��i <br />Existing Use of Building ��%re i' u� �`� I HEAT SOURCE; <br />Proposed Use of Building Cj � c�SS �16�^" kH /1►� } j Sf" �-�"I�t,�t � � 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) : (' /� 1�/ <br />I � .S � -f' (� 1%' V1-C� � f 5S �t r � -�j � �( � � �" L� � l u 'v-� 'hJ / ]? ►' � �� � l (� S 5 0l G i"' i j <br />� � `f <br />�TrS'fis J_��-f/� f i% <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas ranqe <br />..• <br />Unit heater <br />Boiler <br />� Uther <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _,Alteration �Repair <br />Show Number (#) of fixfures <br />I Toilet <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispos� <br />�iotnes wasner <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Flaor drain <br />Roof drains <br />Medical Gas <br />Other: <br />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 lype of work will be complied <br />wiih whether specified herein or not. The granfing 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 wo�k for which application is made and I comply with the State Cont�actors Law 18.27 RCW and 296.200A WAC. <br />j " � � �— <br />� _ /� <br />O uthorized Agent Signature Date (Revised 4/2015) <br />