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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 'O`�3`�Z <br /> 51TE ADDRESS: PROPERN TAX N PERMIT <br /> Z � �� i �'ti 1 L�i� ' I � Cb�l <br /> LEGALIornewconsWclion: ShortPlaVsubtlivision____________________----LotNo._____ (attachcopyollonglegaldescription� <br /> OWNER � � . ,f" PhanelE-mail <br /> 7 . L L��(�' � CIIylStatelZip -�i� , �.� �. G.V <br /> Address , �� "1 � � <br /> CONTRACTOR � �� z� � � L&I Lic. # _ '� �i.d - /' � C <br /> Address <br /> f. i 1 � i , ,, ���i(�! f Phone'Emai� y�J�� .Lf y�— <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT i � f. <br /> 7 �.�c���SK lJ. <br /> ,' �� ' � � CL f— PhonelE-mail �- �S / 7 ^, .S o .�S <br /> BUILDINGPERMITAPPLICATION CON7RACTPRICEOFWORK)��.�__ —_— <br /> Existing Use of Building_______ HEAT SOURCE: <br /> ------------------- <br /> Proposed Use of Building_____ Gas____ Eiectnc____ Other____ <br /> Building lype: __Single Family __Duplex�Townhouse _Multi-Fami�y �Commercial <br /> Type of projecl: _New _Addition _Remodel _Repair_T.I��Sign___Sprinkler___Demolition___Change o(Use <br /> Descriplion o(Work�addifionalapace providedon fhe back/: <br /> `l�� `� l i.t� J <br /> ��/1 �>�ri�(' [,�C�� S�� ''� <br /> Have you startad work(ng without a permit7 ___YES��NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProjecL• ___Nnw__ Addn ___AltcraUon. __Repalr TypeofProJnck __New___Addn ___Altcratlon__.Repair <br /> Show Numbcr(N)ol(ixfures Show Number(p)ollixfures <br /> ' A/C—air handling units j �� Toilet <br /> � Forced air systems / � BalhWb <br /> Gas pipinq � Lavato (wash basin) <br /> Waler healer � Shower <br /> Gas lireplace � � Kitchen sink&disposal <br /> � Gas ran e � Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood � Water heater <br /> '� Ezhaust fan Sink(service/bar/mop/e�cJ <br /> Heat pump � Bacrtflow preventer <br /> Unil healer Urinal <br /> i Boiler Drinkin Founlain <br /> '� Refri eration � Floordrain <br /> Woodstove ' Greaselrap <br /> Duclm Roof drains <br /> �� Olher____ �'�.. Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM o�ner. <br /> Number of HeaAs �� Other. <br /> i hereby cetldy Ihal I have read and examined this application and know lhe same to bo lme and correc�.All pmvisions ol laws and ordinances goveming <br /> tnrs Iype of work will bo cumplied vnlh whelher specilied herein or noL The graming of a permit does not presume to give authonty to violate or cancel <br /> u��•provision o1 any olher slale or local law regulating consWclion or the pedormance of consWction.Thal I am authonzetl 6y the ovmer ol Ihis p�operty <br /> to peAorm tho vrork for which app6wtion is made and I comply with Ihe State Conlraclors Law iB27 RCW and 296200 WAC <br /> '�,,� � � � (�1�/l��l 2_ <br /> OWnn�Aulho ad Agnnt Signaturo Date (Revised 2I20f 71 <br /> �/7 <br /> ✓ <br />