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�L�QC�1d�C �t1iSp�•!f �cRM/�S � <br /> PERIlAIT APPLICA,TION <br /> Bl1lLDINGIMECHANICALIPLUAIIBING/SIGfVISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sl., Everett, WA 98201 -425-?57-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERiY TAX p <br /> 00 ^ sF P,Zog �MJ�S � <br /> LEGAL for new cons�ruction�. Shoh Plal/su6tlivisic��ry�/ Li� /�1�C Lot No.� (aitach copy ol long legal description) �� �Q�� <br /> �Gi:NER / [ - (y�/� 1✓l�G� PhonelE-mail — yp � �y7 � <br /> ddress �S' �j,� � City/Sla�elZip PV (,lV g037� , <br /> CONTRACTOR • N L 8 I Lic.# E 1 G 9G7 �G ' <br /> Address SQ�— � e Phone/Email,,,?S 8yS /y�/o � <br /> TENANT BUSINES'� CONTACT FOR PERMIT /� � �/�sj 9(�/y/p$ <br /> PhonelE-mailC/��j�Q / IV • <br /> BUILDING PERMIT APPLICATIOiV CONTRACT PRICE OF WORK <br /> Fxisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other_ <br /> Building type: ,�Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _IJew _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Derio!ition_Change of Use <br /> Desaiplion of Wo�k(addilional space provided on fhe back/: <br /> /�-� �C. ��� <br /> Havo you started working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOM <br /> Type of PraJecl: _New_Addn _Alleralion_Repalr Typa of ProJecl: _New_Addn _Alterallon_Ropair <br /> Show Number(Ai oI flxtures Show Num6er(p)olllrtures <br /> A/C—air handling units Toile� <br /> / Fomed air systems Balhtub <br /> ,3 Gas piping Lavatory(wash basin) <br /> / Water healer Shower <br /> / � Gas freplace Kitchen sink&disposal <br /> Gas range I �ishwasher <br /> � Cbthes dryer Clothes washer <br /> / Range hood Water healer <br /> Exhaust fan Sink(service/barlmop/etc.) <br /> � Heat pump Back9ow preventer <br /> Unil heater Urinal <br /> Boiler Drinking Founlain <br /> � Refrigeration Floor drain <br /> Woadstove Grease trap <br /> Ducling Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSIOld SYSTEM Other: <br /> INumber of Heads I Other: <br /> I hereby cedify iha�I have reatl and e�amined Ihis application and know the same�o be irue and correcL All pwvisions of laws and ordinances governing <br /> ihis lype ol wvrk will be complietl with whether specified herein or not.The granting ef a pertnil does not presume to give authoriry lo violate or cancel <br /> the provision of any other ate or local law regulaling construction or Ihe peAormance ol constructioa That I am aulhorized by the ovmer of Ihis property <br /> to perlorm the v.o lo i h applicalion is ma e an compl�th ihe S�e Contraclors Law 1827 RCW and 296200 WAC <br /> Own Au[ ri gant5lgnaWre Date (Revised2/2017) ��� <br />