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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBIMG/SIGNISPRINKLER/DEMULITION <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 B AM TO 1 PM <br /> SITEADDRESS: a'.OaenTVTAxa� P MITR <br /> �2 �. �, �� i u�-oas <br /> LEGAL for new conslmction: Shorl PlaVsubdivision Lot No._ (altach copy ol long le8al description) <br /> OWNER � �'�/� �� v PhonelE�mail l�Z � 2 ' Z- �Z � � <br /> Address ��� ��L���. � ' '� � Ue-- City/SfalelZip �' (iC(��� W� l 2C � <br /> CONTRACTOR F�� � - � �'SL . +� O � " L 81 Lic.# �/'�G� � <br /> Address 1\CZ �1-- 2 ���� /_�'� L 1— �' ` � Phone/Email 2�6 S yl .1 rS T , �'������ ..� �'�0\ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT rr� <br /> �/"� ^ PhonelE�mail �� 1� J� \�� �����l � <br /> BUILDING PERMIT APPLICATION COkTRACT PRICE OF WORK -�� � <br /> C <br /> [xisting Use of Ouilding HEAT SOURCE: p <br /> Proposed Use of f3uilding Gas_ Eiectnc_ Olher_ � <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecl: _New _Add�tion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additlonel space provided on the back): <br /> Have you slarted working without a permil7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Project: _New_Addn _Altorelion_Repair Typo of Project: _New_Addn _Alteration_Repalr <br /> Show Numbcr(R)o/Iixfurcs Show Number(NJ o/flxturcs <br /> A/C-air handling unito Talet <br /> Forced air s stems �alMub <br /> Gas piping Lavalo (wash basin) <br /> Water heater Shower <br /> Gas Greplace Kiichen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes dr er Clolhes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/badmop/eta) <br /> Heat pump 13ackflow preventer <br /> Unil heater Uiinal <br /> 13oiler Drinking Founlain <br /> Relrigeration Floor drain <br /> Woodstove � Grease Irap <br /> Duciing � Roo(drains <br /> Other Medical Gas ' <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � NumberofHeads I Other: <br /> I hereby ceAily that I have read and ezamined Ihis application and know the same lo be irue and conecL All provisions ol laws and ordinances goveming i <br /> Ihis rypo ol work will be complied wilh whether specified herein or noL The grantir�g ol a pertnii does not presume lo give authonty lo violale or wncel <br /> Ihe provision of an ther slalo or local law re9u�ating conslrucllon or Ihe pedormance ol conslrucllon.That I am aulhonzed by Ihe owner ol lhis property <br /> lo pertorm�Ihe " rk for which app�lion is made an0 I camply with Ihe State Contractors Law 7827 RCW and 296.200 WAC <br /> —����-_.��_ �/- 22- ( � �( '� <br /> Ow odAulhodzadRgentSignaturo Dale (Revised2/201f) <br />