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PERMIT APPLlCATION <br /> BUILDING/MECHANICALIPLUMBING!SIGNISPRINKLER/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 6 AM TO 4 PM 'Z <br /> SITEADDRESS: �r�O � � VROPERTYT�N � D Qv MIT� <br /> � <br /> LEGAL lor new conslrudlon: Shod PlaVsubtlivislon Lol No._ (a!tach wpy of tong legal descNptlon) <br /> OWNER L(� - - 44 L PhonelE-mall <br /> Address ZD .�C.Q.V /tVG- � �� CflYlStatel'Lip G VtNUN�' �� ,U <br /> CONTRACTOR G7� „ ` L&ILic.# �'tyPL��SSf� <br /> Address ZZ2, J}µ,�PN 1��� (,1�L�k �t I�NH UQ'�'1'LU`1 142� Phone/Email 'Ci0 - (�/ �S�J(�. <br /> TENANT BUSINESS NAME. CONTACT FOR PERMIT /J <br /> C��..,1 SE+ � Y . t� Phone/E-mail cJUL Gr� IviG�CGC�'�rJ.��iCY•LCNn i <br /> BUILDING PERMIT A LICATION ^ CON7RncT PRicE oF WORK Z y.-�`�y— _ <br /> Exfsting Use of Building HEAT SOURCE: <br /> Proposed Use ol Bullding Gac Elednc Other <br /> Buildingtype: _SingieFamily _Duplex_Townhouse _Multi-Family �Commercia� <br /> Type of project: _New _Addition _Remodel _Repalr,�T.l._Slgn_Sprinkler_Demolition_Change cf Use <br /> Desaiption of Work(additional space pro,v�/ided on the back): k � �,,,,cy /....��cy <br /> �(�'L� Tu-�c 1cLY(�G I�-S�'vu�l�^S � �G��}'[.�h � YLWP b�w � <br /> Have you staRed working without a permll7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProJect: _New_AdUn _Alteretlon_Repelr TypeolProJecl: _New_ROdn _Alteratlon_Repalr <br /> Show Num6er(N)ol Ifxfures Show Number(NJ ol flriurea <br /> AIC-airhandlin units Toilel <br /> Forcedairs stems Batl�tub <br /> Gas ipin Lavatory wash basin) <br /> Water heater Shower <br /> � Gas lire lace / Kilchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Waler heater <br /> Exhaus�fan Sink servicelbarlmo letc. <br /> Heat um BackBow reventer <br /> Unit heater Urinal <br /> Boiler Drinking Foun;ain <br /> Refri eralion Z Floordrain , <br /> Woodstove Grease tra <br /> Duclin Roo(drains <br /> � Other Medical Gas <br /> SPRINKLERlSUPPRESSIONSYSTEM � Other: ��j,,�,J. �(,,��„ <br /> � NumberofHeads � Other: <br /> I hereby certiy that I have read end examiiied this applicatlon and know lhe same lo be true en0 corrxl.All provisions ol laws and ordinances poveminp <br /> this type ol vrork will be complieC�+5th whelher specified herein or noL The pranlinp ol a permit tices not presume to B��e eulhority lo violale or cancel <br /> the pmvislon ol any ol�er state or local law repulaling conSWCUon or�he peAortnance ol consWclion.Thal I am aulhotlzetl by the owner ot 1Ms property <br /> to pedorm th�wo or whi pp� alion is made and I compy with t�e Slalo Contraclors Law 18.27 RCW antl 288.200 WAC <br /> � <br /> �,i <br /> ' J-Z�- Jz. <br /> Owner/ oriz d Agenl Slgnalure Date (ReWsedT/2011) <br />