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� �� <br /> PERMIT APPLICAYION <br /> BUILDINGIMECyANICALIPLUMBING/SIGNISPRI�VKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—wvrw ever ttw .c�g <br /> � APPLICATIONS ARE ACCEPTFD FROM 8 AN.TO 4 PM 0�S I <br /> SITEADDRESS: - �C����` PROPE���; . C `, Z3C ��� VERMITN _ <br /> LEGAL lor neweonstrunion: Short PleVsubdiviaion Lol No._ (atlach wpy of lonp lepal descdAtion) <br /> ON'NER U�J N PA �v\U,� kS Pnone/E•meil �(o�- �7�i 'Z�Jb2 <br /> Addrese 2 (1� �'" U{ i " v11GY CitY/SIale2ip y�i1ICIlUC� l�� _ 1 � J.�. <br /> coNtancroa C FF'1 �rc,�n cu�c� �'ml;ncne �a i uo.u CFt•1HE H C� (� C <br /> Address �� • LC�X ��C�� K�i�CIW1G5 U,���. /Ul'C' � Phone/Email y2:�' C��� ' �2%3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> UrJ '"�C'�1�'��1WD(�rj c ifCr[r��y i �o[ Ilr � <br /> Phone/E•mail /2, -$21•)2� JefG�\ � �'�n- ��h[�_(0� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Z C� . <br /> Ezisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gae Eiectnc o�her <br /> Building type: _Sing�e Family _Duplex_Townhouse _Multi-Famiiy ,�Commercial <br /> Type of project: _New _Addition _Remodel _Repair,�T.l._Sign_Sprinkter_Demolition_Change of Use <br /> DesctiptIion oi Work(eddifional spece provided on fhe beckJ: <br /> C1�Y1 �xi5��i�5 �[ U11�, �01�n'�C+ f�tw �.��IfS �D �x�S�i��J CG..C�U,U��! <br /> Have you staAed working wllhout a permit7 _YES �\ NO ' <br /> MECMANICAL PERMIT APPLICATION PLUMBING P�RMIT APPLICATION <br /> TypeoTProJect: _New_Addn Alteration_Repelr TypeolProJect: _New_Addn _Altentlon_Rep�ir <br /> Show Number(MJ o/�xtures Show Number I ol firfuns <br /> AIC—airhandlin unils Toilet <br /> I Forced air s stems Bathtub <br /> I Gas pi in Lavato wash basin <br /> Waler heater Shower <br /> Gas fire lace Kilchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Cbthes washer <br /> Ran e hood Waler heater <br /> Exhaust fan Sink servicelbar/mo lelc. <br /> Heat um I Backflow reventer <br /> Unit heater Urinal <br /> Doiler Drinkin Fountain <br /> Refri eration Floordrain <br /> I Woodstove Grease lra <br /> Duclin Roof drains <br /> Olher Medical Gas <br /> `SPRINKLER/SUPPRESSION SYSTEM other: <br /> � Number of Heads � Other: <br /> I hereby certify thal I heve read end ezamined this appliwlion and know the seme to ba Irue end corteq.All provisions ol laws and ortlinance6 poveming <br /> Ihis type of xork will be complied wilh whether speciGeE herein or nol.The pranting of a permit tloes nol presume Io give authordy to violete or cancel <br /> Ihe provision ot eny other state or local law repuleting consiruction or the pedortnance ol construction.That I am authonzed by Ihe owner o1 this property <br /> to�the v.vAc for wfiich epplicalion is metle and I tomply with the Stata Contradors Lew 1827 RCW and 2962�0 WAC <br /> �,l< <<«c 7J�< «L-, lt�-os-ll <br /> erlAuth�r7xe AgentSlgnalure Dete (Revised7/7017/ <br />