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� � � r�ERMIT APPLICATId�� <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 9 O7_�� <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM e AM TO 1 PM <br /> SITE ADDRESS: PROPERTY TAI(N PERMIT� <br /> l l0`1 t�NIrJE FIE�O WhY EVCREr WA `.u�l � �2 <br /> LEGAL for new wnstruction: Short PlaVsubdivision�33uS�NE �irAGEy�Lot No._l� (atlach wpy of lonp legal descdption) <br /> OWNER � � • „�� ;,��gS NW 1.1.0 PhonelE•meil lyzs) 33� -552L <br /> naa�e5s (�0 6�x I`i�1Z`i ary�s�a�wLa M�w C,:�K WA 9zo�2 <br /> CONTRACTOR C.o� �s-i, � I-IcM�..S N�J LI,C L61Lic.lt C�%RNcNN `14l <% A <br /> (425 i3Y-5.'�e <br /> Address PU Q�� �`�`{Zy (�11u CREElC �Jf4 9`rU�i2 Phone/Email ti�qZC�Ci�:nle.StiN:.HOMFS.ui <br /> TENANTBUSINESSNAME CONTACTFORPERMIT �„�q� ih�Po�� <br /> PhonelE•mail ��{�-5�33�-5555 M�re(,-1fNEF�nrr_Hw+,ES.US <br /> BUILDIIiG PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use of Building_________ _ HEAT SOURCE: <br /> Proposed Use of Building______ Gas_X_ E�ectnc____ Other____ <br /> Building type: X Single Family ,Duplex__Townhouse _Multi•Family _Commerciai <br /> Type of project: �New __Addition _Remodel �Repair__T.I._Sign_Sprinkler__Demo�ition_Change of Use <br /> Descriplion of Work(addilional space providedon fhe 6ack�: <br /> �A-S�c. � y 13 \PC�rJ �-1 G-1 �� <br /> Have you atarted working wlthout a permit7 _YES _�NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of Projecl: `/LN�w_Addn __Allaratlon___Repalr Typ�of Pro�ect: �Nsw__Addn _AIt�nNon_R�pdr <br /> Show NumWr A o//lrtures Show NumMr R of Ilxtun+ <br /> A/C—airhandlin units 3 Toilet <br /> Forced air s stems 2 Bathtub <br /> Gas i in Lavato wash basin <br /> W ater heater Shower <br /> � Gas fire lace I Kitchen sink d dis sal <br /> Gas ran e Dishwasher <br /> Clothes d er I Clothes washer <br /> Ran e hood � Water heater <br /> y Ezhaust fan Sink service/bar/rtw letc. <br /> Heat um BackOow reventer <br /> Unit heater Unnal <br /> Boiler Drinki Fountain <br /> Refri eration floor drain <br /> Woodstove Grease lra <br /> Ductin Roof drains <br /> Other______ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> INumber of Heads Other: <br /> I hereby certily ihal I have read and eaamined ihis application and know the same to be true and wrtecL All provisbns ol laxs and ordinances goveming <br /> Ihis lype ol work vnll bo complied vnth whelher speci(ied herein or not.The grenting ol a permit dces not presume to give authodty lo vSd�le or wncel <br /> Ihe provision of any olber slate or la:al law regulaling conslruction or lhe peRormance ol conslruction.That I am authorized by Ihe owner M this property <br /> lo pedorm Ihe wvrk lor wfiich application is made and I comply v.ith fhe Stale Conlractors Law 18.27 RCW and 296200 WAC / <br /> ����w �.,�th� �'I S �11 1/ � <br /> OwnerlAuthorized Agent Signature Oa�e (Revised 2/2071) <br />