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�ERMIT APPLICATI� <br /> BUILDING/MECHANICALlPLUMBItVGISIGN/SPRINKLER/DENIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www everettwa.org <br /> 5- � _ i <br /> SITEAD��S: � � Q�� � �� PROP[RTYTAXq PER �T# � <br /> � � ' CJ- �`� <br /> � <br /> LEGAL lor nevi consirutlion: Short Plet/suh7ivision Lol No._ (attach copy of long legal descript:on) <br /> OWNER " S/Y)i -fvl Phone/6mail <br /> AUtlress � 2 Lf Q b �r'J� j�� Qy/Slale2�p 1e ���0..'� � <br /> APPLICANT:_Ovmer _Ovme�sAgent Cunlracior onlrac:or'sAgeni `� enartim�siP:o�ao�imm�oi�o�seoiiroTinoo.�.e�c�eowo�i.nrn�sF�.�� <br /> CON7RACTOR �� (�.jNs'�(- P(iwt Sta���� Lic. M �o�ln W P �`l 1`a�Y e�s. u� u 6 39 c�3 0 <br /> Address Z�0 � S � ��(�1S S'T� �'���° P�onelEmaii ZU6 "I�2/)�7 Sot7�Wo����..!;, ,rP <br /> ' CONTACT FOR PERMIT <br /> P�one/E-mail z0( ���4� Z�73 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> ExisGng Use of Budding HEAT SOURCE: <br /> Proposed Use o(Butltling _ Gas_ Eiectnc_ Other <br /> Building type�. �Smgle Family _Duplex_Townhoi Multi-FamAy _Commercial <br /> Type of project. New Addition _Remotlei Repa T.I. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTIONOFWORK(addmona�spaceprov�dedon ack)t //��' <br /> ��L�.U�-riGe. �.�XJS)��h�y 1�t�4i�f ���C� <br /> � %JU/Lt��'�-I C /-�T C.s� �°� �� � S R�Gt� G, r �� CJ <br /> P � � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alleration � Repair Type ol Project: _New_Addn _Alteralion_Repair <br /> Show Num6ci(#J ol/ixtures Show NumOer(pJ o//i+Nres <br /> WC-air handling unds Tcdet <br /> Forced air systems Bathtub <br /> Gas piping ( Lavatory(wash basin) <br /> VValer heater Shower <br /> Gas `ireplace Kitchen sink 8 disposal <br /> Gas range Uishwasher <br /> � Clothes dryer Clofhes washar <br /> Range hood Water heater <br /> Exhaust lan Sir.i:(serviceibadmop/elc.) <br /> Heat pump [3ackflow oreventer(ms�de bltlg) <br /> Umt healer Unnal <br /> [3oiler Dnnkm9 FouNain <br /> Refrlgeration Fioor drain <br /> Woodstove Grease irap <br /> Ducling Rool drams ' <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Otnec <br /> Number of Heads Olher <br /> I heieby certity i�at I have reaa and eaamined I�is oppl:wtion an0 know Ihe samo lo be Ime and correct.Alt proeisions ol lavis and oidiwnces goveming Ihis lype ol�wrk vr[I De campSetl <br /> w;lh�vheNer speuGed herein or noi.T�e 9ranGng ol a permil does nol piesume l0 9rve avihonq to viola�e or canccl t�e provision ol any ot�er staie or lawl law regNaung conslmcoon <br /> Tnat I am auih ! 'Q by t onner o(this pmpeny w pedorm the work lor w�ith appl.cation is made antl I wmply with Ihe S�ale CoNraqors�.nv tB 27 RCW and 296200A WAC <br /> � � <br /> Owner/Authorizetl Agent Signature \ Dale (Rewsed�9/2015) <br />