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PERMIT APPLICATION
<br /> BUILDING ECHANICAL/PLUMBING/SIGN I - -INKLER I DEMOLITION
<br /> Cl'i.°
<br /> '11 � � CITY OF EVERETT PERMIT SERVICE - - –
<br /> 11
<br /> 3200 CEDAR STREET,EVERETT,WA 9:--,-
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov( www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 3 2. /b A1dp r o f , ti61 g 1 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,kco,to-- c.,,c,,Fs r e.e.c TENANT NAME(If Commercial): weL ;a.,z,t-t . ,94-4,4,11,L.
<br /> OWNER MAILING ADDRESS: STREET .7y ,a,, 4 ,r,�
<br /> , - F ��, S''��``' ter'"'h� �
<br /> CITY lf/'-r.T:>'CI'? - +/S'71 STATE ZIP �‘,
<br /> OWNER PHONE: 5'0' g /_Z,cy v OWNER EMAIL: 51 oagkerEr c>, cc,yr;
<br /> CONTRACTOR NAME: OLLS 52r-Is'-
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: so 5 g-yj 2,r;,, CONTRACTOR EMAIL: 5 iv 404_ et,yr
<br /> CONTRACTOR LICENSE#(REQUIRED): /ae) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):-
<br /> PRIMARY CONTACT: FrOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: SM1? & i .2.Y?,
<br /> `' s3--.... C'fL;O(4-.0:i- ) CONTACT EMAIL: .5—koa2T�ci 4.-0 . c;.as>
<br /> BUILDING PERMIT APPLICATION ip
<br /> Existing Use of Building: d i CA ( Contract Price of Work:$ 6000,
<br /> Proposed Use of Building: o ki=p.Tat,.,_.. Heat Source: jas ❑Electric ❑Other
<br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: laCornmercial ❑Industrial
<br /> Type of Project: ONew ❑Addition j5Rermodel CI Repel DT.I. ❑Sign ❑Sprinkler ❑Demolition @Change of U--
<br /> DESCRIPTION OF WORK: Multi/16i
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<br /> c.„,,44-,„ &.o c it i,)$\'.'`r. :t f,- 6. S -, A-ot. S bits a
<br /> ASSOCIATED BUILDING PERMIT#(if applicable: Aie "4” .1. . 11) 3":" ;l-, Coaft i'a eiz.J,
<br /> MECHANICAL PERMIT APPL ATION PLUMBINGyiRMIT APPLICATION
<br /> Type of Project: _New _ Addn _Alt:, .tion _Repair New /7Addn Alteration _Repair
<br /> #of •List of Fixtures of List of Fixtures #°f List of Fixtures #°f List of Fixtures
<br /> Fixtures F ures 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 Sto e ) Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes D :r Hookup .) ,� Qther Clothes Washer Medical Gas
<br /> Range H.•d Of^ Water Heater Other:
<br /> Exhaus' an (1 Sink(Service/Bar/Mop/etc.) Other:
<br /> T 9t41- 5 tfvtc.
<br /> SPR KLER I SUPPRESSION SYSTEM
<br /> remical 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 underany 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 /> tt City of Everett Official Use Only
<br /> \ �17
<br /> ck,,7 PE C f -Oc't`– 00 -
<br /> Owner/Authorized Ag.nt signature Date (Revised 9/23/2016)
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