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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www•evereriv✓a.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TOI PM � O�� �Z <br /> SITE ADDRESS: VROVERiY TAX• PER IT���— � <br /> 1621 California Ave <br /> LEGAL lor naw construdion: Short PlaVsubdivision Lot No._ (attach copy ol long legal descriplion) <br /> ow►�ER: Ciry of Everett Pho�e/E-mail <br /> nderess c�ryisiaierziu: EvOreH, WA 98201 <br /> coNttt�cTort� D. K. Systems, Inc. �a i�ic.nDKSYSI'982L1 <br /> naares,PO Box 886, Burlington, WA Pno�e/emai�360•755-1555 <br /> N U IN NA CON Il� ER I <br /> Village Theater p�onelE-mail Kevin-360-770-7981 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��•�� <br /> Existing Use of Building (� ��D U 1 S 'f��ati��' HEAT SOURCE: <br /> Proposed Use ot Building � ���--� <br /> ._.-- Gas Electnc Othx <br /> Building type: _Single Farnily _Duplex_Townhouse _Mul�i-Family _Commercial <br /> Type o1 project: _New _.Addition _Remodel �Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> DeScnplionofWorkladdi(ione/spacepmvideaonlheback : k� � { '( �i��`� r�°5�` N� ��+' <br /> 2�s�,�i a�c ��,�c ����,� �'„ + ,t��a �� �,, o w r <br /> Have yo�atertad workinp without a p�rmll7 _YES _NO <br /> MECMANIVAL PERMIT RPPLICATION PLUMBiNG PERMIT APPIICATION <br /> Typ�01 ProJacl: _New_�ddn Alhretlon_Rapair TYpa of Pro1Kt: —N°�'—Addn _AksrNlon_RepNr <br /> Show NumWr / olll+tures Slrow Number / of flrfum <br /> AIC—airhandlin units I Toilet <br /> � Foiced air s slems I BathWb <br /> �� Gas i in I Lava�o wash besir. <br /> Waterhealer I Shower <br /> Gas fire lace Kilchen sink 8 dis sal <br /> Gas ran e I' Dishwasher <br /> � Cbthes d er ' Clothes washer <br /> � Ran e hood Water heater <br /> Exhaust fan I Sink service/bar/mo /etc. <br /> � Heat um Backflow reventer <br /> Unit heater � Unnal <br /> �� Boiler i Drinkin Fountain <br /> � Refri era�ion � Floor drain <br /> Wmdstove Grease tra <br /> Ductin I Roof dreins <br /> Other �: 'i Medical Gas <br /> SPRINKLER/EUPPRESSION SYSTEM 'I other: <br /> � Number of Heads � Other: <br /> I hereby certily thet I have read and ezamined Ihis application and know t�a same lo De lrue and wrted.All provisions ol laws and oMinances goveming <br /> this type ol wnrk will be compliad with whether specified herein or not.lha grenting of a permit Oces nol presume�o give aolhority to violale or cencel <br /> the provision ol any other state or local law regulating consiruction or tha paAormanc��ol conslruction.That I am euthonzed by Ihe ovmer of Ihrs properly <br /> to pedorm the v.ork for applicstion is made and I comply wilh Ihe Stale Conlraclors Law 18.27 RCW and 296.200 WAC <br /> � 3- G-�L <br /> (hmerlAuthorl:MApe Sipnatun I <br /> Data (Revisel7/2011J <br />