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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM "� (I�- I <br /> SITE ADDRESS: � � PROPERTYTAXM RMIT�f <br /> ?j �R �({1.�Lt —i� <br /> LEGAI for new conslruction: Shart PlaUsu6division_ Lot No._ (attach copy of Iong legal descriplion) <br /> OWNER (� • � � Ver� PhonelE-mail (� <br /> Address <br /> �' Ci�ylSla�e/Zip GV�(�'f" WA I � � <br /> � i 1 4! - iu LBILic.# � S � ��� � <br /> CONTRACTOR �S (I p n L <br /> Address 29��I S/ 7 � /1 � /l � ZZ� Phone/Emai 2S p • % 0 A!`/`S I l� ^ �Qi��i� <br /> TENANT BUSINESS NA E CONTACT FOR PERMIT <br /> UI Ia ��� Ok�'v ��, �1/�-�(� PhonelE-mail� J/ �� '�U,� <br /> BUILDING PERMIT APPLICATION CON7RACT PRICE OF WORK �" <br /> Existing Use of Building <br /> HEATSOURCE: <br /> Proposed Use of Building Gas Electnc Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli•Family _Commercial <br /> Type of project: _New _Addition _Remodel ,_Repair_T.I._Sign_Sprinkier_Demolilion_Change of Use <br /> Description of Work(addifional spaca provided on the bnck): <br /> Have you sWrted working without a pertnil4 _YES _NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�ecl: _Naw_Addn _Alteratlon_Repair Type ol ProJaU: ,_New_Addn Altantion_Rep�lr <br /> Show Number(N)o�Ilrtures Show Number(M)o/flxtures <br /> AIC-air handlin units Toilet <br /> Forced air s stems Bathlub <br /> Gas ipin 2 Lavato (wash basin) <br /> Waler healer Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clolhes washer <br /> Range hood Water heater <br /> Exhaust(an � Sink(servicelbar/mopletc.) <br /> Heat pum Backflow reventer <br /> Unil healer Urinal <br /> Boiler 1 Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodslove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify Ihat I have read and ezamined Ihis applicalion and know the same to ba Irun and correct.All provisions of laws and ordinances goveming <br /> �his type ol work will be compli �vilh whether specified herein or nol.Tha granling of a permit does not presume lo give aulhority ta violate or cancel <br /> Ihe provision ol any other s o or cal law regulating construclion or the peAarmance ol conslruclion.Thal I am aulhorized Ey Ihe owner ol lhis prope�y <br /> to peAorm Ihe work lor ich lication is made and I c mply wilh the Slale Contractors Law 1827 RCW and 298200 WAC <br /> �� � 3 i� z�i� <br /> Owner� orized Agant Sipnalure <br /> �ate (Revised7/1011J <br />