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1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810–FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S—Q �- <br /> SITEADDRESS: � 1 PHOPERTVTA%N �RMIiN �_ �y:�` <br /> � l/l/� <br /> LEGAL for new construclion: Shoh PlaVsubdivision___—______— Lot No.___ (attach wpy of long legal Oescdptlon) <br /> OWNER � S � (.�� ��1 P�one/E-mail <br /> ddress � _L•�I!'t- CitylSlale/Lp � —Q - `J X 7 <br /> CONTRACTOR L&I Lic.N /1 <br /> Address�"i V V Z,�yd- - .CTY— PhonelEmail � / 7 — <br /> TENANT BU5INESS NAME COPJTACT FO�E`RMI� ^�/� <br /> r J <br /> �/ � � f'ho�u�E-mail <br /> BUILDING P RMIT APPLICATION CONTRACT PRICE OF WORI �J�.Z=_____— <br /> Ezisting Use of Building__ _—_-----__--- HEAT SOURCE: <br /> Proposed Use ol8uilding________--�__—_------ Gas__ Eiectric__ Otner___ <br /> Building type: __Single Family __Dupiex__ Townhouse __Multi•Famil �ommercial <br /> Type of projecl: ___New __AdC�:tio __Remodel __Repair___T.I.�ign__Sprinkler_Demolition_Change of Use <br /> Descriplion of Work(addiConai space provided on the backJ: <br /> (ithS-�'GC� Uti.C- (/�t�P S'✓�� <br /> Mave you staRed working without a permtl7 __YES __NO <br /> MECNANICAL PERMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> Typa of ProJacl: __New___Addn _ AlteraHon__Repalr Type af ProJact: __Naw__Addn ___Albntbn__Repeir <br /> SM1ow Number(NJ o/Iixfures Show NumWr(� oI Nrtures <br /> AIC—airhandlin units Toilet <br /> Forced air s slems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas lire Iace Ki�chen sink&dis sal <br /> Gas ran e� Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust lan Sink service/barlmo /elc. <br /> Heat um Backflow reventer <br /> Unil heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Cuctin Rool dreins <br /> � Other_____ __________ MedicalGas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads I Olher: <br /> I hereby cetlity that I have read and ezamined this aDP�iwtion and know the same to be true and wrtect.NI provisions oi laxs and ordinances goveming <br /> ihis type of xatk will be comp�ied with whether spec�ed herein or not.The granling ot a permit dces nol presume to give aulMrity lo violate or wncel <br /> 1he pmvision of any other state or local law regulating wnsWction or Ihe peAortnance ol construction.That I am authwized by the owner of this propeny <br /> to pedortn the v.ork(or which application is made and I compiy wilh the St te Contractors Law 18.27 RCW and 296.200 WAC <br /> ��� � Z <br /> O er R dzed Agenl Signature Date (Revlsed 7/2011J <br /> �IZ <br />