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( t. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �`- I S-12 <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-ww�v.evereitwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPEnTYiA%p P III,�I_�—!,� <br /> D D vC,k.C►2. GE� cx <br /> LEGAL lor new construction: ShoA PIaVs�bdrcision Lot No._ (altach w{ry of long legal tlescdption) <br /> OWNER (F.vGIQ�' �jw��}.p/ GJ �1Gd PhonelE•mail Z`J- � �f�g�� <br /> Atldress (.C�• 1��� O�� City/StateJZip �V��T �O <br /> CONTRACTOR �V BEL����4I4ht t C. L 8 I Lic.# vP.1�C'1SSD Z�LDT <br /> Address µ� �l!'� TNa �'�� PhonelEmail 'Z .. 'Z�'J 2�3��T <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> p•��� W{R�M��N �� Phone/E-mail �`"'M�'�' � r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�'9�0 <br /> Existing Use of Buildinn MMCV HEAT SOURCE: <br /> Proposed Use af Building J�p'iM� . _ Gas � Eiectric Olher <br /> Buildingtype: _SingleFamily _Duplez_Townhoysr _Multi-Family �Commercial <br /> Typeotprojecl: _New _Addition _Remodel ✓ Repair_ il._Sign_Sprinkier_Demolition_Change ofUse <br /> DeScriplion o(Work(additional space provided on fhe back): <br /> �.�l�c C� K� CkAN� Dv7 pF 3 vvct� �w�g <br /> Have you started working without a permit7 _YES 1�NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT/lPPLICATION <br /> TypeofProJect: _New_Addn _ Alteration Repair TypeofProJecl� _New_Addn _Alteratlon_Repair <br /> ShowNumber(p�o/�xfures ShowNumber N)ol�xf�res <br /> AIC—airhandlin units Toi�et <br /> Forced air s stems Bathtub <br /> Gas i in Lava[o wash basin <br /> Water healer Shower <br /> Gas tire lace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran ehood Walerheater <br /> Exhaust fan Sink service/badmo /elc. <br /> Heat um Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Founlain <br /> Refri eration Floordrain <br /> Woodstove Grease tra <br /> Duclin Roof drains <br /> Other Medicsl Gas <br /> SPRINKLER!SUPPRESSION SYSTEM otr,er. <br /> Number of Heads Olher. <br /> I hereby certiy that I have read and examinetl this application arM knax Ihe same to be Irue and corren.NI provisions of laws and ordinances poveming <br /> this type ot wnrle�HII be complied with whelher specified herein or noL The granting of a pertnit dces not presume to give aulhodry lo violale or wncel <br /> Ihe provision of any olher state or local law regulaling construction or lhe pedormance of canstnxtion.Thal l am eiM1honzed by Ihe owner of lhis pmperty <br /> m pedorm the work for�+hich application is made and I comply with the State Contractors Lew 1827 RCW and 29G.2(!0 WAC <br /> •,,S?o�-- a- �5_ �Z <br /> 9wn¢rhiuthori tlAgentSignature Date (Re�tised22017J <br />