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+. <br /> PERMIT APPLiCATION <br /> BUILDING/MECFiANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedsr St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org _II <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � � <br /> SITEADDRESS: � ,S � �j PROPERTYTA%N pERM�T� �, �-� \ <br /> �o�� - (o `�' / r>r�— <br /> LEGAL for new conslruct�on: Short PlaUsubdivision Lot No._ (allach copy ol long legal descrip�ion) <br /> � � PhonelE-mail �� j- p 7 . - �"�'C <br /> OWNER ��q�^{ rI �t O SU-� 1' (�G�'` <br /> Address �(p(JC � CitylSlale/Zip �, 77 � ( OJ-Cl� <br /> CONTRACTOR .�('�".�G'r��r;/i!!S c( ��t L&I Lic.# SC V O� Y O � <br /> � /� . 1 A � �,�. Phone/Email �J27 -a/jS -d- <br /> Address ��,15 -7� '•�P Lv ��1 i t� PU " 7� <br /> TENANT BUSINESS NAME ' CONTACT FOR PERMIT <br /> PhonelE-mail _rC I( �� �"�/-� 75� ' U <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Proposed Use of Building Gas_ Elec!n•_ Olher__ <br /> Building lype: _Single Family _D�.iplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change uf Use <br /> DesCripti0n of WOrk(addifional spaceprovided on fhe back�: <br /> Have you starled working without a permit7 _YES _NO <br /> MECHANICAL P@RMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProject: _Naw_Addn _Altcretion_Repair 7ypeofPreJect: _New_Addn _Alteratlon�Ropalr <br /> Show Num6er(#)of Iixmres Show Number(N)o/flxtures <br /> � A/C-air handling units I Toile! <br /> � Forced air syslems Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> Wa(er heater I Shower <br /> Gas fireplace � Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> � Range hood � Water heater <br /> Exhaust fan � Sink(service/bar/mop/etc.) <br /> � Heal pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin9 Fountain <br /> � Refrigeration Floor drain <br /> � Woodstove � Grease trap <br /> Ducting Rool drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certily ihat 1 have read and examined this appllcation and know the same Io be irue and correct.All provisions of laws and ordinances goveming <br /> this type ol worK will be complied wilh whe�her specified herein or not.The granting of a permit does nol presume Io give aulhority lo violate or cancel <br /> Ihe provision of any olher stale or local law reyulaiin9 constmction or the pertarmance of cons�mction.Thal'am au�horized by the owner of this prope�y <br /> to perform�he vmrk lor w ich app'cation' matle and I comply with ihe Stale Contrac�ors Law 1827 RCW and 296.200 WAC <br /> � � <br /> /i.. � -� � '�� � (Revised?/2077) <br /> O offA,fl�Brizod Agont Signaturo Date <br />