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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMgING/SIGN/SPRINKLER/DEMOLITION <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 ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS: PROPER7Y TAX k PERMIT q <br /> ��i 4- �,� � > > oo � - , , <br /> LEGAL lor new wnstmc�iort. Shoh PlaUsubtlrvision Lot No._ (atlach wpy ol lon9 legal tlescriplion) <br /> OWNER ' ('� ' � r PhonelE-mail <br /> r <br /> Address C� pa � Ciry/State2ip �, � <br /> CONTRACTOR �1 - . � 1 ��.�j '' L 81 Lic.# 1"��-U �� r�- *'y / <br /> ( ' <br /> Atltlress -i T- c " �j�,��� ('lV � YY(1Q; � Ph e/Emai� - ' - �' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 1 � �,� � - 'T��J - , �"-7"�1 - <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � `I`IC�� "^ <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Eiecxic Other <br /> Building type. �Single family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_SF.rinkler_Demolition_Change of Use <br /> DESCfiption o(Wofk(addRional space provitled on the back): <br /> Have you slarted working without a pormit7 _YES �JO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProject: _New_Addn �OAlteration_Repair Typeo(Project: _New_Addn _Alterotion_Repair <br /> Show Nanrbcr�#)o/Iixfurns Show Number(N)ol/ixtures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathlub <br /> Gas pipin Lavamry(wash �.�a;in) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 uis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbar/mo letc.) <br /> Heal pump Backflow reventer <br /> �:r�it heater Urinal <br /> �oiler Drinkin Founlain <br /> Refri eration Floordrain <br /> Woodstove Grease tre <br /> DucUn Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certAy Ihat I have read and exammed ihis apph[ation and know ihe same to be true and cortect.All pmviswns of laws and ordinances govermng <br /> this rype of wurk��II be comphetl��,�ih�Niether speciLed herein or not The g�anling ol a permil does no!presume Io grve authonry Io violate or cancel <br /> the pmvision ol any other state or local law regulaung consimction or the peAormance of tonstmction That I am authorizetl by the ovmer ol this propeny <br /> to perlorm the work for vAiich appiic��ion is made antl I comply with ihe State Conirac�ors Lzw 18 27 RCW and 296200 WAC <br /> ' � �� �. , � �... f� '� c,�•��II <br /> Owne Authorize gent ignatum\ Dale (Revised22011) <br /> � <br /> \ �I�: <br />