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• <br /> � PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SEI:NI l SPRINKLER I DEMOLLTION • <br /> Cll'YOF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-267-8810 ( FAX425-257-8857 j(E)evereffeps@everettwa.gov www.everettwa.gov/permits • <br /> 1ihits.or lilaa=k litik itis to so . • fP ROJE©T S8T IINFO MA T11ON • - <br /> PROJECT SITE ADDRESS: 6-2 r S Rd 5 71, 5' .A PROPERTY TAX#: <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> (�� 'IA �Bik[ ® yt5 �a®l_l . •. . • . . <br /> OWNER NAME: I 1 A 144, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 152.E _ 403 n� , g • <br /> cnY Li✓C'(Z&Dr STATE Lt/I4, zip i0-Lo J <br /> OWNERPHONE( Z') 'Z?i.- 4+47 ,....... .w» IOWNER EMAIL:L .. .,_ 1..if <br /> ., ... .� ,. .a.,..,.,.,w...-. k.. ., <br /> CONTRACTOR NAME: e U C ik..) 677.4-`ra. �a�arinyt -c. • . <br /> CONTRACTOR ADDRESS: STREET '2 (2..O iscU 1� <br /> CITY �U sTATE {A,,,A.- zip 6P2,20 <br /> CONTRACTOR PHONE: 4s-5-2-52--3/iq • CONTRACTOR EMAIL: g <br /> eP1 zJ €_Qcyy/,�1e,, Ljdppi <br /> CONTRACTOR LICENSE#(REQUIRED): Eariy24.5s®2•20 r CRY OF EVERETT BUSINESS LICENSE#(REQUIRED): 49 a " ' <br /> PRIMARY CONTACT: El OWNER RCONTRACTOR El OTHER(Please Specify) . <br /> CONTACT NAME: CONTACT PHONE: 47 5_'-5-2del f9 <br /> KI"f (52 LC) CONTACT EMAIL: g �S104,a,evsi <br /> .. : .. .. biJIL17IldG P tflilTAPP•LidA` IBM • . . . •. • - — ' <br /> Existing Use of Building: i Contract Price of Work:$ /O ft2O <br /> Proposed Use of Building: Heat Source: DGas *lactic ❑Other <br /> Buiiding Type: SFR Detached CISFR-Attached ODuplex ElMuiti-Family-#of Units: ❑Commercial .C7lndustrfal <br /> Type of Project: DNew ClAdditlon DRemodef ygepair OT.I. Osign r COSprinkler DDemolition ClChlange of Use <br /> DESCRIPTION OF WORK: IZt�plA a If STfs4$$ At1Z t-ke(��►1tt�-+ri ti t`t' He:),.1-7-- Rc • <br /> ASSOCIATED BUILDING PERMIT#(if a.pllcabie: _ ___ _ <br /> ,.• : :!l/I Cli1PJ!(CAL PltlRRilt1 APPLICA` tONki I • , PI,UM)BIl4{0 ifit 6 iVllT APPL1C.ATI(0M • <br /> Type of Project: _New Addn _Alteration_Repair Type of Project: New _Addn Alteration Repair <br /> #of #of j #of #of <br /> I List of Fixtures List of Fixtures i List of Fixtures List of Fixtures <br /> Fixtures Fixtures �Fixtures Fixtures <br /> NC—Afr Handling Units j Heat Pump j 1 Toilet Backflow Preventer(Inside Bldg) 1 <br /> Forced Air Systems : Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain I . <br /> Water Heater . Refrigeration . Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap ' <br /> Gas Range Ducting Dishwasher Roof Drains . <br /> Clothes Dryer Hookups Other: l Clothes Washer Medical Gas ! ' <br /> Range Hood Wafer Heater Other: <br /> Exhaust Fan Sink(Service/BariMop/etc.) Other: <br /> :'&ifili;!IXLt ik I .UPRR SStON sygnivI 1 <br /> Number of Heads <br /> CKNOWLEDGEMENT,•l have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to th/s permit must comply with <br /> 'fired 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 /> ui/ding Official before being authorized under any circumstance.lam the owner,or!am authorized by the owner dads property to perform the work for which application Is made, <br /> td/comply with theSfat$Contractors Law/&2xRCINand 296.200A WAC. ! <br /> / FERMI/,/� City off vereftOficial Use Only ' 1 <br /> kt....-1,-. '4ti/0 ,� H Y.TnIg 01-09 g <br /> 1 <br /> veer/Authorized Agent Signature Date (Revised 5/20/2098) <br />