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� � <br /> PERMIT APPL�CATION <br /> BUILDING/MECHANI(;AL_IPLUMBING/51GN/SPRINKLEFc/DEMOLIT ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> C3-2�0�0 Cedar SL, Everett, WA 98201 425-257-8810 FAY. 425-257-8857 �nnvw.everettwa org <br /> �L.:L�� <br /> SITE ADDRESS: ?� � �,.,t�� ,, /�,, � PROPERTYTAXp !� PERId1T: <br /> ��3 G �P/rG(Y/'�-'/t �N`'+-�',I�� 2� 0`'C"DOJO/C9n200 mi31a — OD � <br /> . — <br /> LEGi'.�ar new conslrucl�an: Short. �UsuOdrvisian_ Lot No_ (altach copy ol long legal tlescnFtian) <br /> OWNER s reL � ,� �/�� PhonelE�mail <br /> Adtlress Cily15talelZ�p <br /> APPLICANT: Owner OwnefsAgent Con;ractor ConlractorsA enl T•�aN� �.,i �a.^ i �e�a:m�.��wermoo,���mao.o�k��ino:�:�.,� <br /> — I= p7� <br /> CONTRACTOR % � . � L � State Lic. K (�� �Vld'�b ✓ City Bus. Lic # <br /> address Phone/ematl <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> � (� e� ,(�e�2+� 2�a-.��G���L e e /�C 2 0 � �/�—���po�'/ <br /> j/ R. PhonelE-ma�l p O�/ � . �1�1CL.N� Cd� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �c'r�o. -- <br /> Ewsting Use of Bwitling ✓�'a-� . HEAT SOURCE: <br /> Proposed Use of Building �- �� /�y_ �� Gas__ Eiec���c_ otner_ <br /> i <br /> 6uiitlmg type�. _Single Famdy _Dup!ex_Townhouse _N'ulU�Fam y �'Commercial <br /> Tyoe of prolect: New Addition �" Remodel _Repair_T I. _Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK/adtlrional space provitled on tho�aci�. <br /> .�,��c� � � � �y�°c—Z �,� u� �;.�-� ���� . <br /> �a-�r.u�- i�,-,L o�. � ' . <br /> MECHANICAL PERMIT APPLICATI N PLUMBING PERMIT APPLICATION <br /> Typo ol Projec�: _New_Addn _Alleration_Repair Typo ol Projec�: _New_Addn _Alloralian_Repair <br /> Sbow Nwrrber(N)o/lix(ures $how Nurtrbcr(N)ol fixfures <br /> A/C—air handlinq unds I Toilet <br /> Forced air syslems Dalhtub <br /> Gas piping I.avatory (wash basin) <br /> � Water heater Showcr <br /> Gas freplace Kdchen sink&disposal <br /> � Gasrange Dishwasher <br /> Cbthes dryer I Clothes washer <br /> � Range hood I N!ater healer <br /> Exhaust fan Smk(servicMbarimopletc) <br /> � Heat pump I Back(iow prevenler <br /> Urnt heater � Unnal <br /> � Boiler Orinking Fountam <br /> Refngeratlon I Floordrain <br /> Woodslove � Grease trap <br /> Duchng Roo(drains <br /> � Other � t�tedical Gas <br /> SPRINKLE<< / SUPPRESSION SYSTEM � Othec <br /> Numb=r of Heads � OU�er <br /> I�eretry ceWy that I Peve reaC antl evnm�netl ih�s app��coeon and know i�a samo to Oe true nnd corrcd.AII provis�ons ol le�vs on0 orE�nances goverNn.;i��s ry0o ol woAe w�il be comF'IeC <br /> wM xnelnM spetT�ea�ere�n or not.Tpn granl�ng ol d OemtA EaeS�cI D�esumo lo grve aulnority to noldlo or wncel�ne prcv4�on ol any ol�er stale or IOwI IaW regulating fAnslNc�ion <br /> Tna1 I am aWnoeize0 Oy inc cwner ol Ini,o�oFeny to pciicrm Ine work lor v,A�ch app!¢a;ion is maGc an71 w�nply wnh Ino Slalc CoNractors la�v 1827 RCW anE 296 700A WAC � <br /> t� � � <br /> OwncrlAulhorized AgenlSiynaWra �� (Revised1201J) <br />