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46-17- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ 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: 3 3Z2)C'' �± sW PROPERTY TAX#: 2_80(4- I ZOO 30S`/0O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LAI is_.93 I P"S L111(/ LL-c---• TENANT NAME(If Commercial): p-e (z,, me., .b6vokp h <br /> OWNER MAILING ADDRESS: STREET 7 034 IA �� 5 31W f(� <br /> CITY l�PW,AA,(�+�-+/L_- STATE w "" ZIP 50-)._ 6 <br /> OWNER PHONE: fr/T OWNER EMAIL: /`J / IA ,_CONTRACTOR NAME: E \ y?...._ ([/V`��,�5 �--(---C.--- r ' <br /> CONTRACTOR ADDRESS: STREET /la-LA) <br /> � 0 0 E C.J ) 54 <br /> [ <br /> CITY / O N STATE (,�✓ ZIP q,c-30s- 7 <br /> CONTRACTOR PHONE: 1-425— ZO-7 - 0058 CONTRACTOR EMAIL: 171,1 6,--n-- a m.(iL ,C.t5A-4 <br /> CONTRACTOR LICENSE#(REQUIRED, 24A4c.,.,L 4 2....4 F EVERETT BUSINESS LICENSE#(REQUIRED):514 CJ ' 1 <br /> PRIMARY CONTACT: El OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (0 _ 1.---)1.---)— 1 2_(4 i <br /> l(1711 141( P n JOS 11 CONTACT EMAIL: (AA 6 i;r— v-t 1z,//4--(4_j, G_.c7i/�/t <br /> BUILDING PERMIT APPLICATION 1` <br /> Existing Use of Building: (4-)1-1 S Contract Price of Work: $ 1 keit ( 00' 0 <br /> Proposed Use of Building: bu N S CJI . z(&C f -,5 Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial Ilndustrial <br /> Type of Project: ❑New DAddition DRemodel DRepair STA. ❑Sign Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �;vet 1A�D i5 J (_5�� g►4-(s Olt- r0.-Lt€— ( "` iv! <br /> I4' <br /> ert4 0 C I w I or{-(�s . $p e_e_A AL_ � 6 Pl •S ") ' :72-e-411. <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 List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit 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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> 1 Chemical or Water I 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 /> all, c .../1 _ <br /> 312112,0( 6 PER T# <br /> Owner/Authorized A ent Signature ate (Revised 9/23/2016) 'J <br /> L <br />