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i <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� �' �I <br /> SITE ADDRESS: PROPERTY TAX N PERMIT i <br /> ��I Pe�lc`� / - <br /> LEGAL for new construction: Short PlaVsubdivislon lot No._ (altach copy ol lonp legal description) <br /> OWNER ,(3�7c�t.�q �{�PcJ�t( PhonelEmail .�dv- 65'3-193L <br /> Atldress ,�U �/ C�c k�5 CitylSlate/Zip E V�7'r (,,,,�yF <br /> CONTRACTOR QCat���5 �N✓hs�¢. i.tC_ L81 Lic.!! y66 y��0 - 00 dol �2 3 � S � N b 1 <br /> Address ,U (f�K !1$� `N� ✓h�� L�1✓1- �5TyS7,' PhonelEmail �/ y- r� J-2 �" ,�. _ <br /> TENANT BUSINESS NAME //27�2 CONTACT FOR PERMIT . <br /> cv /�/ o� <br /> PhonelE-mail �2�?i�I` I O �� <br /> BUILDING PERMIT APPLICATION coNTRACr PRlce oF WORK <br /> Existing Use af Building S�• .. � -��+�%/ HEAT SOURCE: <br /> Proposed Use of Buildinq S � Gas�L Etectric Other <br /> Building type: �Singie Family _Duplex_Townhouse _Multi-Famiiy _Commercial <br /> Type of project: _New _Additian _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change oi Use <br /> Description of Work(addifional space provided on the back): <br /> Have you atarted working wlthout a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot ProJeet: _Naw_Addn _Alleratlon_Repair Typa of Project: _New_Addn _Altention_Repalr <br /> Show Number(N)of/irtures Show Number(N)o/Rirturee <br /> AIC-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> •7 Gas pipin Lavato wash basin) <br /> Water heater Shower <br /> Gas f replace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbar/mo /etc.) <br /> Heat pump BackOow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> �ucting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> 1 hereby ceniry ihat I have read and examined this application and know the same lo ba true and cortect.AII provisions ol laws and ordinances goveming <br /> this type ol work will be camplied with whelher specified herein ar nol.The granting ol a pertnil does not presumx�o give authoriry lo vioia�e or cancel <br /> ihe provision of any other stale or local iaw reguiatirtg construction or the performance af construction.That I am authorized by the owner of this properry <br /> lo perform Ihe work lor which application Is made antl 1 comply wilh ihe State Coniractors Lew 70.27 RCW and 296.200 WAC <br /> �/.�,/���L ir-iy_�, <br /> �r orfzed yentSlgnawre Date (Revised7/2011J <br /> � � <br />