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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-881U—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �- a D ��Z <br /> PRO ER7YTA%p PERM.IT rl'^� <br /> SITEADDRESS: � .� _ 1 2�� Z��zfp>r `'� — vv <br /> Id <br /> LEGAL for new wnstructiarr. Shurt Platlsubtlivision _Lot No._ (aUach copy ot long tegal description) <br /> OWNER �. n 'L Phone/E�mail �� — 8 <br /> Address �� aOfp �'I l � city/state/zip ���/— � Q <br /> CONTRACTOR Ld�.( - G�AJ '� L&I Lia# LT d - <br /> Address �� 'V 7 PhonelEmail Z 0(4 3y �Z 3 Q <br /> TENA�N1T BUSINESS NAME ONTACT FOR PERMIT �-�` Fy���p�� <br /> ��,/��fL� J �JIY�� PhonelE•mail �L �(i ^ � � <br /> BUILDINGPERMITAPPLICATION CON7RACTPRICEOFwoRK, CO�f �r� '— <br /> � [�.!��(Z� HEATSOURCF.: <br /> Exisling Use of Buitding �F�—�F' <br /> Proposed Use of Building �'�'�� � ��� Gas X Electric_ other_ <br /> Buildingtype: _SingleFamily _Duplex�Townhouse _Mulli-Family _Commercial . <br /> Typo of project: _New ,_Addition _Remodel _Repair.�,T.l._Sign_Sprinkler_Demolition_Change of Use <br /> Description o(Work(additianaf space provided on Ihe 6ack): <br /> Have you started working without a permit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBtNG PERMIT APP!LICATION <br /> TypeofProJect: _New_Addn _Alleration_P.epair TypeafProJoct: _New_Addn _Alteratlon_Repair <br /> Show Number/N)oI flxfures Show Number(#)of flzfures <br /> � A/C—airhandlingunits L I Toitet <br /> � Forcedairsystems � Bathtub <br /> Gas piping { Lavato (wash 6asin) <br /> � Water healer Shower <br /> � Gas fireplace Kitchen sink&dis osai <br /> Gas ran e Dishwashe: <br /> � Clolhesdryer I Clotheswasher <br /> Range hood � Waler heater <br /> Exhausl fan I Sink(service/bar/mop/etc.) <br /> Heat pump � Backflow preventer <br /> Unit heater � Urinal <br /> Boiler � Drinkin Fountain <br /> � Refrigeralion I Floordrain <br /> � Woodslove Grease trap <br /> � Ductin � Roofdrains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Nuinber or Heads I Other: <br /> 1 hereby cetliy that I havo read and examined this application an0 know Ihe same to 6e true and corred.All provisions ot laws and artlinances poveming <br /> Ih���s rype of vmrk will be wmplied vnth whether specifed herein ot not.Tha granting of a permit does not presume to give authoriry to vlolale or cancel <br /> the pmvislon ol any olher state or tocal law regulali�coriSf2tlon ar the performance ot coretruction.That I am authorized by lhe owner of this properry <br /> to perton 4he vrork for which apD�ic ' n is madr�.��ypry��h tho State Contractors Law 1817 RCW and 298200 WAC <br /> i <br /> �//��� i � - 2�-1� <br /> OwnedAulhodzed Agent SI9imWm / <br /> �ale (Revised?/2011J <br />