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. ERMIT APPLICATIO�. <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 9II201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED fROM 8 AM TO 4 PM <br /> SITEADDRESS: � PROPERTYTAXk � ,c .�th7fl7Ccl PERMII;lIfl3-II�) <br /> I ,Iln I ilh S�rccf <br /> LEGALfornewconstruclinn• ShortPlaVsuodivislon ��� .�[t:tc�ic�j �a�N ti« .\t4�fiAc��Copyoflongle9aldescription) <br /> OWNERI'ru� i�cncc Rct�iunal ,Uc�lical (:cnrcr 1?ccrctr pnonelE-mail ��7-�(�l-�i�G <br /> ndtlress Ii31 Colbc :A��cnuc cnylSiaie2�p I�.ccrct[. AV`:198311G <br /> CONTRACTOR ���-�• ���������'���011 L&ILic.1k <br /> Addiess ��71) �i.�{. �9t�1 ���acc, �3c��c��uc, ���:� )�111U% PhonelEmail�}�J-89J-)Uflfl <br /> TENANT BUSINE9S NAME CONTACT FOR PERMIT ti���tt :�n�3crson <br /> ��'� PhonelE-mell '���-��i�--�J$�� <br /> BUILDINGPERMITAPP�ICATION CONranC7PRICEOFWORK 51.����!����� <br /> ExistingUseofBuilding � lu�pi�:il .\ddition H[ATSOURCE: ��-� <br /> ProposedUseofBuilding IlusplCil .��Ic�iUon _ Gas_ Elac�nc_ Olher_ <br /> Euilding type: _Sinole Pamily _Duplex_Townhouse _Mulli-Family \ Commercial <br /> Typo of project: _New �Addition _Romodol _Repair_T.I._Sign_Sprinkler_Oamdition_Chango cf Use <br /> DesCriplion of Wofk(addifionai space provided on(he 6ackJ: <br /> Ruild out uf shcllcd m:iin kitchcn sp:uc un l.c�cl li-I ��I nc�c huspital trn�cr. <br /> Have you started warking wlthout a permit? _YES t NO <br /> MECHANIGAL PERMIT APPLICATION PLl1iMBING PERMI7 APPLICATION <br /> TypeofProjecl: _New_Addn _Alteretion_Repair TypeotProJect: _New_Addn _Alleralion_Repair <br /> ShowNumber N o/Rxfures ShowNumber(K)o/Rxtures <br /> � A/C—airhandli unils Toilel <br /> � Forced alr s stems Bathtub <br /> Gas plpin Lavatory(wash basin) <br /> Water heater —r Shower <br /> Gas fireplace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Cfoihes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhauslfan Sink service/badmo lelc.) <br /> Heal pump 8ackflow preventer <br /> � Unit hea�er Urinal <br /> Bdler Drinkin Founlain <br /> Refri eration Floor drain <br /> Woodstovo Greaso tra <br /> Duclin � Roof dralns <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Olher: <br /> I Number of Heads Olher: <br /> I hereby certily Ihal I have read and ezamined Ihis applicaticn and knovi the same to be tiue and conecl.All provisions of laws and crdinances goveming <br /> lhls typo of vrork wl!I be compliad wilh vAiethor spocified horaln or not.The grnnling of e p:rmit does not presume to glve a�lhorily to vlolato or cancel � <br /> the p vi �on of any other stale or local law mgulaling consWclion or Ihe pedortnance of construction.That I am aulhor'aed by Ihe ovmer of ihis property <br /> to p�orm th work forwhich appliation is made and I complywilh the State Conlractors Law 1827 kCW dnd 296200 WAC <br /> 3�17 � <br /> Owner odud A�ent Sic�nalurc �ale (Revised 712071) <br /> \utc: Chcd; t�I 391991 tiir 57,1�ti.�� �o hc :i����licJ t���c:ird huil�lin,� �urmit fcc n<�r�Inn fcc. � � <br /> � :1 <br />