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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLiJMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 - •425-257-8810— FAX 425-257-8857 —wvnv.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AD�RESS: PROPERT,Y TAX q PERf.11T# <br /> ��Q�� `(1��'l��-C;�� U�L�� ii �- '. b - 0'3 <br /> LEGAL(oi new canstrvcl��on: Short PIaUs�btlrvismn Lot No. (atlach copy ol long le9at descriplion) <br /> OWNER ���� � � � 'vi(���`� � l.�i,. Phone/E-mail q��.0• �� �' 1`� � <br /> AUdress �.� :`.'v��C �,` � —(7 �I Ci1ylStale/ZiP �[�'l'�1� �ti � 10 �` l <br /> CONTRACTOR ����L ��Y � �I ! 8 I Lic # . ��GtC� 11C•�C'��(�� �� <br /> �tltlress��1� 4'^ L� 1��,.y1 ����LL' ' Phone�[mfii �--�• 2��' 1 9"� <br /> TENANT BUSINE55 NAME 1`) • ��ONTACT FOR PERMIT <br /> �CY�CI aL� . � ��- ��,�,�� 11� an�ii� c PhonclEmail, `��Z ��zcj• ��j Z \Q�O�- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �7,U D <br /> Existing Use of Bwiding �i�wL�N.�/y,^, 11,t' HEAT SOURCE: <br /> Proposed Use of Building �� Gas Eiecmc� O�her <br /> Buildinr, type. 1Sirgle Family _Duplex_Townhouse _Mul�i-Family �,Commercial <br /> Type ol projecf. �i. New _Atldilion _Remodel _Repair_T.I. _Sign_Sprinkler_Demolilion_Change of Use <br /> Descnption of Wo7k(adCdional space pmvrded on(he backJ: <br /> 11��-�-� �� �+r���� S�i,t� I�.tc�� ,�r��.� 5���`'� <br /> Have you sWrted wor�ng without a permit7 _YES�NO � � ' <br /> MECHANI�AL PERMIT APPLICATION PLUMBING PERMIT APPLI�ATION <br /> TypeofProjecC _New_Addn _Alloralian_Repair TypeolProjecl: _Nuw_Addn _Alloralion_Repair <br /> Show Numbcr(N)ol�xWics Sbow Numbrr(pJ ol Ortures <br /> A/C—air handling unfis I To�lel <br /> Forced air syslerns Balhtub <br /> Gas piping Lavatory(wash basm) <br /> � Wa�er hea�er � ' Shower <br /> Gas fueplace Kitchen sink &disposal <br /> Gas range Oishwasher <br /> Clolhes tlryer Clothes washcr <br /> Range hood Water heater <br /> Exhaust fan Sink(servicelbar/mop/elcJ <br /> f lea�pump Hackllow preventer <br /> Unit heatcr Urmal <br /> l3ailcr Drinking Founlain <br /> Refngeralion Floordrain <br /> Woodslove Greasc Irap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> INumber of Heads Olher: � <br /> I hereby certity Ihat I have read and ezamined Ihis applicalion antl know Ihe same lo be Irue a;id cortecL All provisions ol laws and orCinances govemmg <br /> this type a(woik will be complied with whelher;pecifietl herein or nof The granling ol a permit dpe5 noi pre5ume lo give aulhorily lo violate or can<el <br /> Ihe provision ol any olher slale or local la�v re9ulaling.conslruclion or Ihe pertortnance of conslmclion. That I am aulnorized by Ihe owner ol lhis pmperry � <br /> to perlorm ihe work for which applmalion is made and I comply}hlh Ihe Slale Conlraclors Law 1827 RCW and 296200 WAC <br /> I L� I (' \ . / I ��t I I� <br /> OwnorlAulhorizod'At�ont5ignaturo i Date (Reracd7/201i) <br /> � <br />