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( � <br /> PERMIT APPLICATION <br /> BUILDING!MECHANICAUPLUMBlNG/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -42�-257-8810—FAX 425-257-8857—www.everettwa.`or�y/L <br /> APP4CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I I <br /> SITEADDRESS:LIB�3 �U�S 1CP��^� PR�U,SIIRppOttLjl�1 PERMITt _�S <br /> LEGAL(or new construction: Shart PlaVsubtlivision Lal No._ (attach copy of long legal description) <br /> OWNERTS4a0 SC ��-'��r � As.x• ��c Phone/E-mail <br /> Adtlress� C� �(C4$ � �` ��� City/Slate/Zip � �1� 9 8�U8 <br /> coNrr�croR c � S� d- (k1�N �•s�k �s i uo.# �•SA o38 Q E <br /> 26v8 flw °14 .5�� IMc� T��w 41f� `t82� 3Go- 4�y-�sar <br /> Atltlress V.w •1 3 PhonelEmail � 11�WE �.rf •W <br /> TENANT BUSINE 1S1NAME CONTACT FOR PERMIT �'(� Y�G(,� <br /> (1� C\ r '�{l` I V�Q i� Phone/E-mail �p a �� W e � SL U .CU� <br /> BUILDINGPERMITAPPLICATION cONrHac7PRICEOFwoRK �!� <br /> Existing Use of Building `� F �k�.'� So��M HEAT SOURCE: <br /> F�oposed Use of Building �<< � N� S���"� Gas_ Eleclric_ Other_ <br /> Building type: _Single Family _Duplez_Townhouse _Mulli-Family _Commercial <br /> Type of proJed: _New _Addition _Remodel _Repair_T.I.�Sign_Sprinkler_Demolition_Change of Use <br /> Descfiption of Wofk(addifional space p/ovided on fhe back): <br /> �ew,ouL kl.�.� R�- c�s�'t e��5�� `'"`k( Sr'�v� � <br /> Have you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATICN <br /> TypaolProJact: _New_Addn _Allarallon_Repelr TypaolProJact _Naw_Addn J1lbntlon_Rep�lr <br /> Show Num6er(N)o//Ixturos Show Number(N)o/fl+funs <br /> A/C—airhandlin units Toilet <br /> Forced air s stems Bathlub <br /> Gas i in Lavato (wash basin <br /> Waler heater Shower <br /> Gas fire lace Kitchen sink 8 Jis osai <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hootl Water heater <br /> Exhausl tan Sink(servicelbarlmo letc. <br /> Heal um Backflow reventer <br /> Unil heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floor drain <br /> Woodstove Grease lrap <br /> Dudin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ $UPPRESSION SYSTEM Other: <br /> Number of Heads Olh=r: <br /> I hereby certiry that I have read and examined�his appliwtion and know the same to be We and cortecl All pruvisions of lavrs and ortlinances goveming <br /> this type ot work will Ee wmplied with whelher specifed herein ar not.The granling of a pertnit tloes no�presume to give authonry to violate or wncel <br /> the provislon of any other state ar local law regulaling wnstruction ar the peAotmance of consWction.That I am aut�orized 6y the ovmer o1 this property <br /> to peAorm lh� applicalion is made antl I wmply wilh Ihe Slate Conlraclors Law 18.27 RCW and 296.200 WAC <br /> . l� -{U—1 2 <br /> OwnerlAuthorizedAg tSlgneture Date (Revised?12a17� <br /> L <br /> 2 <br />