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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMQING/SIGNISPRINKLER/aEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—�,w✓�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: �7 �I �n /�= \ �! PROPERTYTA%p` s �L'i�1L{3/YX� PERMITk ^ <br /> f � /,G'� � � rZ�o . �- , ^ o > - ' <br /> LEGAL lor new constmclion Short PlaUsubtlrvision � . � la py of long legal descnption) <br /> OWNER;� C� 1�C� �i rG � PhonelE-mail � '� '-,/ <br /> '� 1'�� � City/StatelZip � �i . �I�lr' Wr1 G/ <br /> nddress �j <br /> '� - ,Ly L 8 1 Lic.# <br /> CONTRACTOR " , . k •. � <br /> Address PhoneiEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT � G ���-��Z���j <br /> �G /��. ' j�,,..tc..�\J 3 Phone/Gmai 1r ��� ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � ' a <br /> Exisling Use of Building l � HEAT SOURCE: <br /> Proposed Use of Building Sas__ Eixtric_ other_ <br /> Buildingtype: _SingleFamily _Dup�ex_Townhouse _Muiti-Family Commercial <br /> 7ype of project: _New _Addilion _Remodel _Repair�T.I._Sign_Sprinkler_Demolition_Change af Use <br /> Destriplion of Work(adtllhonal space pmwd on fhe back/: <br /> Ca�s%hv����/cc� � �e���/�,��x 1V�t�� r�� �x/511i�oJ �i9�l�if' �>« <br /> Have you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICAT[ON <br /> TypeolProJect: _Naw_Addn _Alleralion_Repair TypoofPrqoct: _New_Addn _Alteration_Rapair <br /> Show Numbcr fp)ollixtares Show Namber(p)ollixrores <br /> AIC—air handling unils Toilet <br /> Forced air s stems Bathtub <br /> Gas pipin I Lavato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposai <br /> Gas ranqe � Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water healer <br /> Exhausl fan Sink(service/bar/mop/etc.) <br /> Heat pumo Backflow preventer <br /> Unit he=!ar Urinal <br /> Buiier Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodslove Grease trap <br /> Ductin I Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � NumberofHeads Olher: <br /> I hereby certdy that i have read antl examined this application and knrnv the same to 6e lrue and wrrect.All provisions ol laws and ordmances goveming <br /> Ihis type ol wvrk vnll be complietl�hlh whether speafied herein or not.The granting o1 a permrt tlxs not presume to give authoriry to violate or cancel <br /> Ihe provision of any olher state or local law regulatmg conSWction or lhe pedormance of constmction.That I am authorized by lhe o�mer ol this property <br /> to peAor 11� or;for which a h ade antl 1 comply Wth the Seate Contractors Law 18 27 RCW and 29E 200 WAC <br /> % �� •� n9�b2 11 <br /> wnerlAuthorizeA Agent Sigwtu�e Date (Revisetl2/1071) <br /> �I1 <br />