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<br /> � CITY OF EVEREI"T P�Rf�fI1T' SIE13V10ES
<br /> 3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-8857 www.everettwa.org
<br /> SITEADDRESS: ; �� _ �: � , , , PROPERTYTAX# PE MIT# � �
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<br /> L�GAL for new construction; Short Plat/subdivision Lot No, (attach copy of Ibng legal description)
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<br /> , _. - � . . <<. ;; r�- Phone/E-mail � -_ ~ t; • ,
<br /> OWNER �: �., ;i _, . � .
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<br /> Add�ess _ f ,' .i • "",. -y` Cily/5tate/Zip '�_ , � , ..t—, - _,
<br /> APPUCANT:_Owner _Owner's Agent _,Contractor�_Contfacto��s Age�t _Teflant(musl provida a letler of consenf from lhe owner to dp work In�he space)
<br /> CONTRACTOR ' ;��;,' � -'-j•Y^-�:. 4- � �� State Lic,# "� �?= "'.�:` � City�us. Lic.#u��'J(
<br /> � " ., .._,�'. :� ,,: ,.j Phone/Email ,� � _ e� -7 �
<br /> Address �' . .. :_{y /��..r� =i , _ _ _. .'S `� • `r 5 .
<br /> CONTACT FQR PERMIT L �� „
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<br /> Phone/E-mail d�'cl .�:�Sc:-� ._',. :_tl�:1 �a<_��.,d'L.-� 5 - l c: � .
<br /> BUI�.DING PERMIT APPLICATION cONTRACT PRICE OF WORK � � � t ' '
<br /> Existing Use of Bullding ��� HEAT SOURCE:
<br /> ��,.ri.�°�;�c_. Gas Electric �ther
<br /> Froposed Use of B�ilding — • —•
<br /> Building type: �Single Family �uplex_Townhouse _Multi-Family ^Commercial
<br /> Type of project: _New a Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_�hange of Use
<br /> DESCRIPTION OF WORK(additional space provided on the back):
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<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 fixfures 5how Number(#)of�xtures
<br /> A/C–air handling units ; Toilet
<br /> Forced air systems Bathtub
<br /> Gas piping LaVafory(wash basin).
<br /> Watef heater Shower
<br /> Gas fireplace Kitchen sink&disposal
<br /> Gas range Dishwasher
<br /> Clothes drye� Clothes washei
<br /> Range hood �' Water heater
<br /> - Exhaust fan ,f ' Sink (service/bar/mop/etc,)
<br /> Heat pump Backflow preventer(inside bidg)
<br /> Unit heater llrinal
<br /> � Boiler Drinking Fountairl
<br /> Refrigeration Floor drain _
<br /> Woodstove Grease trap
<br /> I Ducting � Ropf drains
<br /> � Other Medical Gas
<br /> SPRIPd��ER / S�IPI��i��SDOB�9 �XS p`fI�N1 Other: ..
<br /> Number of Heads Other;
<br /> I hereby certify ihai I have read and examined this appilcation and know{he same to be true and correct.All provisions of laws and ordinances governing lhis lype of work will be complied
<br /> wilh whelher specified herein or not,The granting of a permii does noi presume to give authority io violate or cancel ihe provision of any oiher siaie or local law regulating conslrucfion
<br /> l'hat I am authorized by ihe owner of this property to perform the work for which application is made and I comply with the Siate Contractors Law 18.27 RCW and 296.200A WAC.
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<br /> OwnerlAuthonzed Agent Signature Date (Revlsed 4/2015)
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