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( � <br /> PERMIT APPLICA�ION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTE�FROM 8 AM TO 4 PM �� a '� � <br /> SITEADDRESS: � �� PROVERTYTAI(N PE I;(� � v2� <br /> Z. �Z' ORs Jc � -Q-� � �' <br /> LEGAL fw new construclion: Shon PIaUwDdivision Lot No._ (attach copy of long lepal descnption) <br /> OWNER f� i � t Phone/E-mail �. 'Z. 'Z` �.� <br /> Adtlress i d CirylStatelZlD CJ�.e�� � Ol0 ; <br /> CONTRACTOR L&I Lic.M IJ � I <br /> Atltlress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 1 S Q�.. 'ul P�oneJE.mail� �N ' ��'�J � J � � <br /> BUILDING PERMIT APPL CATION CONTF aCT PRI e oF WORK 6,680 <br /> Existing Use o1 Bui�ding HEAT SOURCE: <br /> Proposed Use ol Building D��i C c Gas Electnc Other <br /> Buildingtype: _SingleFamily _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: _New _Addition _R�model �Repair_T.I._Sign_Sprinkler_Demo�ition Change of Use <br /> Descrip�ion ot Wotk(atlCdional spare provitletl on Ihe 6ack): <br /> �:P�Acr �=rt.rte S"rst�+�U�S� <br /> Fiave you startad working without a pertnit7 _YES �NO <br /> i <br /> MECFIANICA� PERMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> Typa ot Pro{ect: _Naw_Atltln _Altantlo�_Repelr Type o(ProJecl: _New_Addn _Altantlon_Rep�ir <br /> � <br /> ShowNumDer N)olflxturas ShowNumDer N o/flxturas � <br /> AIC—airhandli units Toilet � <br /> Forced air s stems Bathtub ` <br /> Gas i in Lavato wash basin l <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&tlis sal <br /> Gas ran e Dishwasher i <br /> .:iothes d er Cbthes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbarlmo etc. <br /> Heat um Backflow reventei <br /> Unit heater Unnal <br /> Boiier Drinkin Fountain <br /> Refri eration Floordrein <br /> Woodstove Grease tra <br /> Ductin Roof tlrains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby certy that I have read antl examirKW lhis appiwlion anC knav ihe same to be We and correct NI pavisions of laws anC orUinances poveming <br /> this type of warlc vnll De compiietl vnth whet�er spec�0etl herein or nW.The g2nting of a pertnit does not Drewme to give aulhority to�idate or rancel <br /> Ihe prov�sion of any other state ar iora�law reguiaUng construa�on w Ne ce��ance ot wnstrucnan.Tha�I am auMorized by Me rnmer of Mis propeM <br /> lo peAorm t�e�nork kr v,fiiU appliwtion is matle anA I wmdY�+����e State ConVadors Law iB,27 RC W and 296.200 V�AC <br /> �.� � ��6�2�11 <br /> Ovme ulhorized gan Signature ate lRevise0?/t071) �� <br /> 2 <br />