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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLlJMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.eve�ttw�or� 3 <br /> pROPERTY TAX N P RMI <br /> SITE A DRESS: I �5 �-U� <br /> LEGAL for new constr�ction: Short PlaVsu6divislon Lot No._ (altach copy ol long legal descriptian) <br /> OW NER .y PhonelE-mall <br /> Cily/Stale/Zip <br /> Address <br /> APPLICANT•_Owner Owner'sA�enl Contraclor _Contractor'sAgent _Tenanl�mus�p�o�;eeaianara��nsemo-ommeennenoaoWor�inmesoaca� <br /> CONTRACTOR G. Stale Lic.# JOUTNCAI 30v City Bus. Lic.# <br /> Address ,p, O <br /> -OI$7 Phone/Emai 1 ^�73 7 <br /> TENANT BUSINE S NAME CONTACT FOR PERMIT <br /> T1 `� 11 � Rti✓��b J Grfaot- PhonelE•mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Gas_ Eleclric_ O�her_ <br /> ?roposed Use of Building <br /> Building type: _Single Family _�uplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(addifionel space provided on fhe back): <br /> f7�Jf� 13EGJ �iflfl'tTz66rn � � °` r^�rs�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypcofProjocl: _Now_Addn _Alloration_Ropalr TypoofProJocl: _Now_Addn _Alteretlon_Repalr <br /> Show Number(N)o(/ixfwes Show Number(#)o/lixtures <br /> � A/C-air handling units I Toilet <br /> � Forced air syslems Bathtub <br /> � Gas piping Lavatory(wash basin) <br /> Water healer I Shower <br /> Gas fireplace I Kitchen sink 8 disposal <br /> Dishv+asher <br /> � Gas range � Clothes washer <br /> � Clothes dryer � Waler heater <br /> � Range hood � Sink(service/bar/mop/etc.) <br /> � Exhaust(an � <br /> Backtlow areventer <br /> � Heal pump � Urinal <br /> � Unft healer I <br /> � Boiler Drinking Fountain <br /> � Refrigerafion - I Floordrain <br /> � Woodstove I Grease trep <br /> Duding I Roof dreins <br /> � Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> Number of Heads � Other. <br /> I hereby cetlify thal I havu read and examined this epplicalion anA knmv Ihe sama to 6a Wo ond mrtect.All pmvisians ol laws end oidinances goveming Ihis lype olwork will be wmplied <br /> vrith whMher specifie herein o�not.The 9ranting ol a permit does nol presumo to 9ive aulhority to violate or cancel Ine pmvision ol any ather state er local law regulating constmclion <br /> Tnat I n a orized y Ihe owner o/tNs propetly lo perlorm Ihe�+rork lorw�ich applicalion Is maCe and 1 comply with the Stata Contractors Law 1827 RCW and 296 2WA WAC. <br /> " J/Z��' (Revised 32013) <br /> OwnorlAuthorizod Agont Signaluro Date <br />