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PERMIT APPLICATION <br /> BUILDI�IG/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857 —www.everettvJa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: 11 PROPERNTAXN P M�T# _ �.�5 <br /> �� � �- J 1 1 (_ - ��['��- �_. � ���L'L� � <br /> �� 1 �1 rVi� N IC �. �—C"� �c: <br /> LEGAL for new consimction: Shotl PlaVsubdivision�-�i�f�+�5 ��u� �1� .,CL �C`�Liol No.S T (attach copy ol long egal description) �' ' � <br /> OYJNER���� ' iy � Phone/E-mail - ��� ���' � . !: <br /> Addrnss� • .jC- �} I � City/State/Zip � ' � r� � <br /> CONTRACTOR / � �i� L&I Lic.# <br /> Address PhonclEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �I �� . <br /> PhonelE-mail . Y ��� "1 c�I � � <br /> SUlLDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use of Buildin9 HEAT SOURCE: <br /> Proposed Use of Building �'7 � ��"� P _ Gas_ Electric Other_ <br /> Building type: Single Fam'ly _Duplex�_Townhouse _Multi-Family _Coinmercial <br /> Type of projecC �,New _r`ddiGon _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> D2sc�iolion of Wo�k(addilional space providedon the 6ackJ: <br /> / I <br /> �_�n p� CC.e cl C. ��c� �L't C�'�i� <br /> � n <br /> Have you started working wilhout a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLllMBING PERMlT APPLICA'YION <br /> Typo of ProJect: _New_Addn _Altaration_Repair Type of ProJect: _New_Addn _Alteration_Rapair <br /> Show Numbc�(#)o/fixfures Show Number(N)o/tix(ures <br /> � A/C-air handling unils I, Toilet <br /> � Forced air syslems _ I Bathtub <br /> Gas piping I Lavatory(wash basin) <br /> Walerheater � Sho�ver <br /> � Gas f replace I Kiichen sink 8 disposal <br /> � Gas range � Dishwasher <br /> " ( Clolhes dryer � Cloihes washer <br /> �� � Water heater <br /> � Range hood <br /> Exhaust fan � Sink(servicelbadmop/elc.) <br /> Heat pump � BackOow preventer <br /> � Unil heater Urinal <br /> Boiler � Drinking Fountain <br /> Retrigeration Floor drain <br /> � Wocdstove � Grease lrap <br /> Ducting � Roof drains <br /> � Other j Medical Gas <br /> SPRINKLER I SUPPRESSION SYSS'EM I Other: <br /> Number of Heads I Other: <br />�_ <br /> I hereby certity Ihat I have read and examined this application and know�he same lo be irue and correct.All provisions of laws and ordinances governing <br /> this type o(v�ork will be complied with whr.lher specifed herein or noL The gran�ing of a permit does not presume lo give authority to violate or cance <br /> Ihe provision ot any olher stale or local la.v regulating cons�ruc�ion or Ihe peAormance of consiruclion.That I am authorized 6y the owner of this property <br /> lo perfoJmih vmrk lonvh' i applicafion is made and I comply vrth the State Contractors Law 18.27 RCW and 296.200 WAC <br /> �� �� �, �,�-` t'YJLl%n � �� � � I I <br /> OvmedAuthorizc Agent Signature �- Da�e (Revised 22077) <br /> �C- <br />