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PERMIT APPLICATION S'-►i --►z <br /> BUILDING/MECHANICALIF'LUMBIIdGISIGNISPRINKLERIDEMOLITION <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 8 AM TO 4 PM <br /> SITEADDRE.�iS: PROVERTYTA%p .� ' Z PE MI M . � <br /> �1G - v�S�`^ , L �� 0(�>I OU l -CiZ <br /> � LEGAL for new construction: Short Platlsu�division Lot No._ (atlar,h copy of long Ir.gal desaiption) <br /> OWNER 62�G � �2i O M G �% T � LLA PhoneiE-maii yoZ'�J ^ �J�J�S "" �`� 53 <br /> Address q (i �p - c� � 't� �n\V �=- �J� CirylS�ate2ip � � F �t '1 � � � "`�U � <br /> CONTRACTOR A�V AN� K D /iJ �TA L l-/�L'T�o/� L 8 I Lic.# c�c�Jc..��� p 3`�S c�J ,O�c . 3 <br /> Address 1 (o '� U wl "1 ` � 1 C� Phone/Email �-I �5 - ��I S - S�/ �� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail r�c N��•�h o^^c A7T . ^� �T <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��55 �5 0 � O <br /> Existing Use of Building �E.S 1 � � N�� � ��'- HEAT SOURCE: <br /> Proposed Use o(Bu� ing �'�S � �! L N �� 1 R l� Gas_ Electric_ Other_ <br /> Building type: Sir}gle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> ' Type of project: ,�[New _Addition _Remodel _Repair_T.I.,_Sign_Sprinkler__Demolition_Change of Use <br /> � DeScription of Work(atlditional spcco pmvided on fhe back): , A S � � � � ,� S�A �- �- <br /> . G itS .�J'f O J � I N 5T Fl 1� � C � �- G <br /> �hcutt� � <br /> � Have you started workin�without a permit7 _YES _NO <br /> MECHA ICAL PERMIT APPLICATION PLUMBING PERMIT APPLlCATION <br /> Type ot ProJect: _New_Adtln _Altenllon_Repalr Type of Project: _New_Addn _Altention_Repalr <br /> Show Number(M)o//ixNres Show Number(N1 0/17xtures <br /> AIC-air handlin units I Toilet <br /> � Forced air s stems I Bathtub <br /> � � Gas pipin I Lavaro (wash basin) <br /> � Water healer i Shower <br /> � '� Gas fire lace I Kitchen sink 8 dis sal <br /> Gas ran e I Dishwasher <br /> li Clothesd er � Clotheswashar <br /> � Ran e hood i Water heater <br /> � Exhaust fan I Sink servicelbar/mo letc.) <br /> � Heat um I BackFlow reventer <br /> � Unit heater I Urinal <br /> Boiler I Drinkin Foun:ain <br /> II� Refri eration I Floor drain <br /> � Woodsrove I Grease tra <br /> Ductin I Roof dreins �. <br /> I 0!her � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i rvner: <br /> Number of Heads � Omer. <br /> I hereby certify that I have reatl and esammed this aoplicalion ana know the same to be true and wnect.All provisions of laws and oNinances goveming <br /> this type of vrork will be compiied with whether specifed herein or noL The grenting of a permil dces not presume to give aulhority to violate or wncel <br /> the provision of any o�her slate or local law regulating consiruction or Ihe peAormance ol construction.That I am authonzed by lhe ovmer of this property <br /> lo peAomi Ihe WorlSfor which app�liwtion is matle and I comply wilh Ihe State Contractors Law 7827 RCW and 296200 WAC <br /> 1����1�--� U S-/t,�-�Zb/Z- <br /> 1 (Revlsed 2/2011) <br /> Owner� thorized Agent Signature Date <br />