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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL I PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • �� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4/V f q Flo p5 t�Gt.i 44/j (/rrG�f�Ir/� g9ZQ1}PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Phi/y.5 d S p®t ((oaf f.i47 / ,/TENANT NAME(If Commercial): �i f C <br /> OWNER MAILING ADDRESS: STREET ff3 / IVO/1 k/G/Ce. /.2r �/ <br /> CITY (/ C i dj AC /`. STATE 42 J�/ZIP I s "/y <br /> OWNER PHONE: �j 13 - ei 2 LI - -70go [WNER EMAIL: 44 GUu//lQ4C��f 1:105i.dij tail ,LQ elf <br /> CONTRACTOR NAME: Air 4j' 9/u+4OI : kt,,rt.trea.‘„ .er ,eA- ek , <br /> CONTRACTOR ADDRESS: STREET 'Z 21.13 tl 7 ZN I eve 5 <br /> CITY /Ce / STATE k/4- ZIP 7 g 032 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): a(46-�rr1 '?33. /J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):#056 5- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: > CONTACT PHONE: �f(j - 3©d 71st / <br /> /V �e 1,0 ���O�rGreve CONTACT EMAIL: a A#14/s "at ='_,.._ *re S/o' d . C Off( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Othe <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ►• -. mercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel 1 2ei5air ❑T.I. ❑Sign ❑Sprinkler ❑Demolition "-we of Use <br /> DESCRIPTION OF WORK: IJep€-t 45 4e7/%9/1/''v. -/' ®01 arc hij SGr� <br /> AP,- 1°15 't r,.:5,4 i c- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of Lis ures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat ump Toilet ow Preventer(Inside Bldg) <br /> Forced Air Systems Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink isposal Grease Trap <br /> Gas Range Ducting Dishwas Roof Drains <br /> Clothes Dryer okups Other: Clot Washer Medical Gas <br /> Range Ho ater Heater Other: <br /> Exhaus an Sink(Service/Bar/Mop/etc.) Other: <br /> S INKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads • <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMITo3- o?S <br /> 3/ i/ 18 CZ <br /> O3 <br /> Agent Signature Date (Revised 9/23/2016) <br /> �1� <br />