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• • <br /> PERMIT APPLICATlON <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINN:LERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wv✓w eveietywa.org <br /> �{'b � <br /> SITEADDRESS: VRO�P!EHTYTAXN PER�d1T" ) <br /> �,310 �NO�JSM- S 28 Zuo�/C>Z�GC� <br /> LEGAL for new con;lrucl:on� Shoh PlaVsubdrv:sion Lot Ho_ (����cn ccpy M long le9al tlescnp0on) <br /> O Fj�� �S � /J� ��,T`• PhonelE�mail <br /> aU�'ss �' ,. }'t/((i�l CA--� ��/C G�ry�S�ate2�P �.+�4.1!�.� 1 ��i 1-.�G <br /> • ' <br /> A�PUCANT: _Ormer Ownersa9enl Comrac�or Conlraaor'sAGent _Tenanl�m.�v.ro�m�.,�<n:r�i«,sr��o-o„�noo..�:,��oe_�:�����u�.o;c�wi <br /> CONTRACTOR K. �D f I YNo�1� �l.l� State Lic. # RO Pw�i�S�t Cily �us Lic. #OSZs r <br /> �1d;lress c-1 }o )..J(�' �,—]��' $� 1,� E yvy PhorelEmail ��'o � ]Z �S � <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> i3� '12 ��tZG S �:,C..� Z.C� 3-I Z-1 (0�"-7 <br /> FhonciE�ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3uU� �� <br /> Existing Use of Bwlding HEAT SOURCE. <br /> PropOsed Use Of Bwlding Gas__ Eieclnc_ O�her__ <br /> Buddmg rype�. _S�ngle Family _Dupl?x_Townhouse _Mulu-Family Z{Commercial <br /> Type o(pro�ect. New Adddion Remodel _Repau JG T I __Sign_Sprinkler De��iol�tion_ Change of Use <br /> DESCRIPTION OF WORK �aaa�oonai space p�cv�dea on tne back�� <br /> i`1C,�,S �c�5'"�('�'JU�"� �I-�.u�-��IC>ti) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMlT APPLICATION <br /> Type ol ProjocL _Now_Addn _AI[er,lion_Repair Type ol ProjecL _New_Adtln _Alleration_Repair <br /> Show Number(x)o/lirfuics Show Num�er(u)olliz(ures <br /> NC-z�r handling units I Toilel <br /> Forced air sysfems Balhtub <br /> Gas piping J � Lavatory (wash 6asin) <br /> ' Water heater I Shower <br /> Gas fireplace � Kitchen sink&disposal <br /> Gas range � Dishwasher <br /> � Clolhes dryer I Clothes washer <br /> Range hood bVaterheatcr <br /> Exhaus�(an � Sink (servicelbadmopletc) <br /> � lleat pump � BackOow preventer <br /> ' Um� healcr Z.,. j Urinal <br /> � k3otler � Dnnking Fountain <br /> I Refngeralion I Floor drain <br /> Woods!ove Giease irap <br /> Ducling _ � Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM � other <br /> Number of Heads � Other: <br /> i nere6y cemty Inal I�ave read an0 cRam�ne0l�is aOP�<aiion anG know Ine samo lo Ge Irue ana wrreq 41I provrsions ol laws end orOmances govemmg���s�ype cl vioM1 rr.'�I�c wmpi::a <br /> v,Lh�.nelner soeufira herem m not.Tne g�ar,Icg ol a o^�it tloes nol presume lo grve aulnortly lo v�alale cr cancel Ine pmvison el any ciner staie or lo W I law regvlaLng con;L2rtHcn <br /> T�al I am aulM1cn.cd Oy�he cwner ol l�is property lo pedorm I�c wo�k tor�rM1¢tl apP����'��on is matle anOl comply w�p I�e Stale CCnlra,rors Law 19 27 RCW anG 796 2 WF YJ.1C <br /> IG���7� �` / L l � 1 S' � <br /> OwnedAuthorized Agen naluro �ale (Rewsed 3�1077) <br />