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( . <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKL.ER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PR�P�RTY TA%p P�R1�1yT 1�.�Q <br /> (c (� IS Commer� 1 � aOS4�) ooC�DoRoo (.vv G <br /> LEGAL lor new consiruction: ShoA PlaUsubdivislonS,�_��Q Lot No._ (altach copy ol long legal desuipibn) <br /> OWNeR , ' Phone/E•r�ail �ZO��' V� - D�I Cp <br /> ddress �Q �� (DZ CitylSlatUZIP W�� �-t� 4 <br /> CONTRACTOR 6 L&I Lic.# V� G) <br /> ddress � �� PhonelE ail SG N��-. <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> PAondE-mall Z�� -- 1 I 1 — L��� <br /> BUILDINGPERMITAPPLICATION CONTrincrPRlcEOFWORK r �� -�' <br /> F�cisting Use of Building p�.���'e� �-� HEAT SOURCE: �F- d <br /> Proposed Use of Building �PSi��P-��-' _Gas Eieclde X Olher - ( /� <br /> Buildingtype: X SingleFamily _Dupiex_Townhouse _Multi-Family _Commercial . <br /> TypeofproJecl: _New �Addition _Remodel _Repeir,_T.I.,_Sign_Sprinkler_�emolition_Chenge ofUse <br /> Desc�iplfonofWo�ic(addifionalsparoprovidedonfheback): bA���j- �- ��d G���� 1�, <br /> ex� S�L1g t 6i�y res��i�cQ wit� �.ew <br /> wiiL. 1,�.¢-w Si�t-ucturo� l walls a�..a� ft�W�a�aHv�_ r� <br /> Have you started working without a permit? �C ,YES _NO Rep�,i 1d. a►�.�e �n �X�sfi� a�9 �'�`x <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaofProJect: _New_Addn _Alteradon_Repelr TypeofProJect: _Naw_Addn _AltereUon_Repair <br /> • ShowNumEei(qa//IaYwes ShowNumber(it)o/llxturea <br /> A/C-air handlin units I Taiiet <br /> Forced air s s;zms Bathtub <br /> ' Gas i in Lavato wash basin <br /> � Waler healer Shower <br /> Gas Tire Iace Kitchen sink 6 dis osal <br /> Gas ran a Dishwasher <br /> Clothasd er Clolhaswasher <br /> Ran e hood Water heater <br /> Exhaustfan Sink servfcelbarlmo /elc. <br /> Heat um Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodstove Grease tra <br /> Ductin Root drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM � Other:5� -� <br /> Number of Heads Other. <br /> 1 hereby certiy that I havu tead and examir_d this applicallon and know ihe same lo be Inre and cortect.All provlslons of laxs end ortfinances 9oveming <br /> ihis lype ol work will be complied wilh whether specified herein or not.Tho granl ing of a permit dces not presume to give auNori�y to vblata or wncei <br /> Iho provlslon ol any olher slata or Iaal law regulattng conslruclion or the peAormance ol consWction.That I am authorized W lhe owner ol lhls pmperty <br /> to pedorm ihe work for which epplicalion Is made and 1 compN vnlh lha State Conlractors Law 18.27 RCW and 298.200 WAC <br /> �� � �(�tc-'12 <br /> Owne Authorized Agen igneture Dale (Revised 7/2011J <br /> -�,�Q y e,a Y-e� _ `(,e,,,ti D e���'^- ��i <br /> y � s - 3��- ���s_ <br />