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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar S[., Everett, WA 98201 -425-257-8810—FAX 425-257-8857 —www•everellw�o`i� _/3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PROPERTY TAX Y P�RMIT# /� <br /> SITE ADDRESS: . . � (}CD— i.�/ � <br /> r' Z .L'�lj � � 1 � � � . � � �..](L� <br /> LEGAL lor new construction� Shon PlaVsubdivision___________ . --- --------�ot No._____ (attach copy ol long legal descriolion) <br /> OWNER .t� ���1 U�� .�C-� J����V�-� -- PhonelE-mail <br /> n � <br /> Address � .`�l t.� _�. �fl l" ': >�� �l ���( y�f-c,�.11: , Ci�ylSlatelZip � l.'E L�.['f'f• (,L,�r�\ � �i Zc-� <br /> .L(,ti-\ S L81Lic.# I�C'!'�1 I\ . + 6 <br /> CONTRACTOR ��I ���L� N _ � � �� —7^7 <br /> �" �,) . ��f>.�- 1— ����i � � 1� PhonelEmail L�[_ � ! /(/,'J�3�� <br /> AdOress (.�� �`Yt.Q.C<<�����'\ C.!� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> , 'l�'Zi�' c�. �C.�lICS <br /> .� L �� (. V\✓� .�1�� ��U"i`u � Phone/E�mail �IL � J I(()S S�jS <br /> BUILDINGPER ITAPPLICATION CONTRAC7PRICEOFwoRFF_�J ���------------ <br /> HEAT SOURCE: <br /> Exisling Use of Building_______ ___.____-------------------- <br /> Gas Elect�ic Other <br /> Proposed Use of Buildin9--------_------------------- � - <br /> Buildin9 rype: ___Single Family ___ Dup�zx__Townhouse ___ Multi-Fam1i�ly _x Commercial <br /> Type of projeck ___New ___Addition ___Remodel ___Repair___T.L l�_Sign___Sprinkler___Demolition___Change of Use <br /> DeScriplion 0f W ork(additional space pmvided on fhe back�: <br /> � �'\S�l�C( 2 � ��c�E� t��U''� <br /> Have you slarted working without a permil7 ____YESt�___NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProject: __ .New ...Addn . AlteraUon___Ropalr TypnotProJacL• __New___Addn _ _AlteraUon_._Repair <br /> Show Number(N o/lixtures Show Number(#)o!fixtures <br /> AIC-airhandlin unils / Toilel <br /> � BslhWb <br /> Forced air s stems Lavato (wash basin) <br /> Gas pipin Shower <br /> W ater healer <br /> � Gas Gmplace Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> �� Clothes washer <br /> Clothes dryer Water healer <br /> Ran e hood <br /> � Exhaust lan Sink(servicelbadmopletc.) <br /> Hea�pump Backflow prevenler <br /> Unil heater Urinal <br /> [3oilm Drinkin Founlain <br /> Relriqeration I Floor drain <br /> , Woodslove Grease tra <br /> Duclinq Root drains <br /> Other___. _____ ______ Medica!Ges <br /> SPRINKLER I SUPPRESSION SYSTEM Othcr: <br /> Number of Heads Other: <br /> i hereby cenity Ihal I have read anC examined Ihis applicahon and hnow the same to be We and cortect All prc.icions of laws and ordinances goveming <br /> ;ins lype of work vnll bo complied with whether specilied herein or not.The granting ol a pertnd does nol presume to give authonty to violate or cancel <br /> r.m provision ol any olher slate or local law regulaling consiruclion or Ihe peAormance ol consiructioa That I am authonzed by the owner of Ihis propeAy i <br /> t,�p, the work lor v,4ich application is madz and 1 comply with lhe Stale Coniraclors Law 1827 RCW antl 296.200 WAC i Zj <br /> / <br /> �� ��� %� ���'"� � � �Remsed 2i2011) <br /> OwnerlAutti'orized Agonl Signalurc ���e <br /> i <br />