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' � PERMIT APPLICATI�.J <br /> BUILDING/MECHANICALIPLUMBINGlSIGN/SPRINK�ER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES g�07�(( <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITEADDRESS: PROPERTVTAI(11 PERMIT //0�_n <br /> �Ainl6 FIE�O WhY EucRET� WA �..��1 L <br /> LEGAL for new conswction: Shon PlaVsubdivision�P,dkSTar�E�a?8�_.�.__� o.�Z (atlach copy of long IeBal description) <br /> OWNER - �� at.�CS NW 1.1..0 Phone/E-me11 �y25� '>3� 'S5� L <br /> Address rJ 6�Y 1492Y CityBtate/Zip (��� CwEEK Ii.1J1 `fi�.'c <br /> CONTRACTOR (_,,,� =us—�. � HoM�..S N�� U.0 L d I Lic.M C�%RN c HN `14l �= A <br /> i �� PhoeEmal;v S�JL <br /> Adaress Po Qur � 142y (�1�u CREEX 1�JR 9�J"�2 :"IAT�@'Vnr.lc•StiN:.MJMES,uS <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �„�p,� �rv�Po�-R <br /> Phone/E•mail ��'1�-5�33�-5555 M�Qc,-�.N'S�nnr_H..r..cS.US <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK — <br /> Ezisting Use o(Building ______ _ HEAT SOURCE: <br /> Proposed Use of Building______�___�--- Gas_X_ Eiedric____ Otner____ <br /> Building type: x Single Family __Duplez_Townhouse __Multi•Family __Commercial <br /> Type of project: _�New __Addition ___Remodel __Repair__T.I._Sign_Sprinkler___Demolition_Change of Use <br /> Descriplion o(Wotk(addifional space provided on the back�: <br /> Nave you started workiny without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Prof acl: �New_Addn __ Altentlon__Rep�ir Type o}ProJ�et: �N�w_AdAn _Albration___R�palr <br /> Show NumWr It of Ilxtums Show NumWr R of Rxtuns <br /> A/C—air handlin units 3 Toilel <br /> Forced air s stems 2 Bathtub <br /> Gas i in Lavato wash basin <br /> Water healer Shower <br /> Gas fre lace I Kitchen sink&dis sai <br /> Gas ran e Dishwasher <br /> Clothes d er I Clothes washer <br /> Ran e hood 1 Water heater <br /> y Exhaust fan Sink service/barlmo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Rool dreins <br /> Other__________ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> INumber of Heads Other: <br /> I hereby ceAify�hat I have read and ezamined this applicalion and know lhe same to be lnre and cortect.All provisions of laws and ordinances goveming <br /> Ihis type of work will be complied wilh whether specified herein or nol.T�e granting o1 a permit dces rrol presume�o give authority to violale or wncel <br /> Ihe provision ol any olher slate or local law regulating construclion or Ihe peAormance of conslr�ction.That I am eNhorized by the owner ol�his property � <br /> to pcAorm the vrork lor which application is made and I comply with the State Conlractors Law 1827 RCW end 296200 WAC <br /> ,, Z <br /> yi?,,w �,,��r.,✓ 8 f I 5 �i� <br /> OwnerlAulhorized Agent Sipnaturs Date (Revised LYOf 1J <br />