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C � - <br /> F�ERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEh70LITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 1 PM I I �-Q� `/ <br /> SITEADDRE�S�: PROPERTYTA%M P RMITM <br /> yy q ovt8/9ooao 2 da o I I 1 D-(�S <br /> LEGAL lor new corehuction: SM PI subdivision Lot No._ (aMach cop�of hrg legal descriptbn) <br /> OWNER � Ynl�VtfD�4�/A LLL PMneIE•mail <br /> ndd�ess G�o /2ao S /�// f��� CitylStatu2ip <br /> CONTRACTOR L 8 1 Lic.# <br /> Address �fL_ Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT - ' p <br /> Ri� s�-.n f/cwv.� b: %�u�, �1.. <br /> Phone/E-mai� ! NvJ <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFwoRK�l2�d�v <br /> Existing Use of Building R/TF' /}'/L7 /�'�E1tG�1/Uu77� HEAT SOURCE: <br /> Proposed Use of Bui�ding S1F7f�1 Q-1 ��'hYld1N-! Gas Electric Other <br /> �uilding type: _Single Family _Dupiex_Townhouse _Multi-Family �Commercial <br /> Type of project: �New _Addition�,Remodei _,Repair_T.I._Sign_Sprinkier_Demolillon_Change of Use <br /> D�scrlptlonofWork(eddd'analspaceprovidedmthabec(0: �� �t, ,. _ _ /� <br /> �easts+��r,c.� consvifivt�+a R..o^, Ru.tir-�-o -�w. .�P� a''r�J <br /> Me�ify Fo�.,�7 bo�.�4/•ca... <br /> Have you slarted working without a permil7 __YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Project: _New_Addn �Altaation_Repalr Type o(Project: _New_Addn _Alteration_Repair �'. <br /> Show Numbar(N)o/RaTu�es Show Number(#)o!fixfures � <br /> � A/C-air handlin unils Toilet <br /> � Forced air s stems ' BathtuS <br /> � Gas pipin Lavalo (wash basin <br /> Water heater � Shower <br /> Gas fireplace ' Kilchen slnk 8 dis sal <br /> Gas ran e � Dishwasher <br /> Clothesd er I Clotheswasher <br /> � Ran e hood Water heater j <br /> Exhause fan Sink(servicelbarlmo /etc.) <br /> � Heat um � BackOow reventer '� <br /> Unit heater � Urinal � <br /> � Boiler � Drinkin Founlain <br /> Refri erelion i Floor drain <br /> � Woodstove Grease tra <br /> Ouctin � Roo(drains <br /> � Olher Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM � Other: <br /> Number of Heads Other. <br /> I hereby certify lhat I have read and examined this application and krwwtM same ta be truo and cortect.All provisions of laws and ardiriances goveming <br /> this type of rwrk will be complied with xfiether specified herein or not.The graMing of a permil does not presumn to give a�6hority lo violate or cancel <br /> the provisbn of any other stato or laal Ww reguWGrg construction or the peAormance of constmction.Thal I am aullwdzed bythe owner of this propnrty <br /> to pertorm tho vro�c for which appl'watlon is made and I compy wilh the Stale CoMractors Law 18.27 RCW and 29G.200 WAC <br /> IN'— � - ����i�/� <br /> O dAuthoriz � Ay al5ignature Dale (Revised7/2011) <br /> G <br /> II� <br />