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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.or/g `� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C�! <br /> SITE ADDRESS' PROPERN TFX p PERMIT t! <br /> i� -� � � ��� � o -ol �-1 <br /> LEGAL for new wnslruction: ShcA PlaVsubdivision Lol No._ (attach copp ol long legal tlesaiption) <br /> OWNERj�,7 • j=G�S�[ F�7� Phone/E-mail � � . � <br /> � .� f C'J�z c� -207�� cty�iat�z�a L!r-'/c��� ��' ., / �C'� <br /> Address%�""// •�j ��t.. - <br /> CONTRACTOR i � I '� L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> � r <br /> `C$ �r � f C//��G��{fp/. � � PhonME-mail ���V� Z.�— CJ�— . <br /> BUILDING PERMIT ANPIICATION CONTRACT PRtCE oF WORK <br /> Existing Use of Building L��'��� -�' �� HEAT SOURCE: <br /> Proposed Use of 9uiiding Gas_ Electric_ Other_ <br /> Buildingtype: ,_SingleFamily _Duplex_Townhousa _Multi•Family _Commercial <br /> Typeofproject: _New _Addilion ,_Remodel _Repair_T.I._Sfgn_Sprinkler�Demolilion_Changa o}Use <br /> DEScriplio�of WO�k(adCilional spzce provided on Ihe 6ack): <br /> D<�mu �.,hsct�� �anopy -� b�;ck �rcfh. <br /> Havo you started working without a permil7 _YES �NO <br /> MECHANICALPERMITAPPLICATION PLUMBING PERMITAPPLICATICN <br /> TypoofProJecL• _Nuw_Adtln _Atlerallon_Repalr TypaofPro)ecl: __New_Adtln _Alteratlon_Repalr <br /> Show Num6cr(N)olOxfurcs Show Number(pJ ol Bxfures <br /> A/C—air handling units Toilet <br /> � Forced air s stems I Balhtub <br /> Gas i in I Lavato wash basin) <br /> � Waler heater � Shower <br /> � Gas fireplace Kitchen sink 8 disposal <br /> Gas ranyo Dishviasher <br /> Clothesd er � Ciotheswasher <br /> Ran e hood � Water healer <br /> Exhaust fan Sink(service/bat/mo /etc. <br /> Heat um Backflow preventer <br /> Unil heater Urinal <br /> Boiler Drinking Foun�ain <br /> Refrigeralion Floor drain <br /> � Woodslove I Grease trap <br /> Ouctin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/SUPPRESSION SYS7EM Other: <br /> � Number of Heads ( Olher. <br /> I hemby certiy that I havo read and examined this appliwlion and kncw the samo to be tma and wrrect.All pmvisions of laws and ordlnances govemin� <br /> ;his type of e�ork will be complietl vnih whMher specified herein or not.Tho granling ol a permit does not presume to give authority to violate or wncel <br /> ;he provision ot any o!her slale o�local law iegulaling consiruction or lhe pedormanco ot cons Wction.That I am authotlzed by l�e ovrner ot lhb properry <br /> lo peAorm ihe wrork fw whieh applieation Is rJWdo and I wmpy�x�lh ihe Stale Conlraelors Law 18.27 RCW and 296.200 WAC <br /> . q /� �' <br /> / _ <br /> . � '. C-✓'c..� .� 1 �t�/��• �� <br /> Owncr/Authodzed Agent SlgnaWre Dale (Revised7/2017J <br />