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PERMIT APPLICATIOIi— <br /> "IIPAI .-44 BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Flea J PROJECT SITEINFORMATION <br /> PROJECT SITE ADDRESS: /Ja y/--AV'e- PROPERTY TAX#:045-42$/6/C9oq,o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. <br /> OWNER NAME: _ cv-j� Cpryc.„( eh®, C „� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 26161 ('edar CIL <br /> CITY Eve„-c_# STATE A//,4' - ZIP '7 6 2....0,rOWNER PHONE: 9'2S 3 99' 7 o / OWNER EMAIL: creel cI iG-0 1 f 1.1 e 0 v-. <br /> CONTRACTOR NAME: Co✓tce j # Rh..( It=s -s t v—a,to (P.._0 <br /> CONTRACTOR ADDRESS: STREET 2 7 2 { <br /> O 8�^ ST -Q5774 <br /> CITY c) C 1 ( r STATE C..) ZIP Seo/2_,--)742 <br /> CONTRACTOR PHONE: Zo(, 4/C /G(' 7 6CONTRACTOR EMAIL:rAft:rZe64cepAkA,lIe/-fs,t,,..f., cow <br /> CONTRACTOR LICENSE#(REQUIRED): 6O 2 - at?S�- q5 o ® CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (s.-3 lc/ I <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTH (Please Specify) <br /> CONTACT NAME: /}4'i( 0000640 CONTACT PHONE: ({2 C et 7 7 - S-5 22. <br /> (PC CC 0Al C 517 6 9(2-N F( / ) CONTACT EMAIL: dJ aioocQ/,Jor"I-4 ?c—a 604. ©V, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:/4/44,44 s f 6,t-lr-«,,,-4 6-a&/s Contract Price of Work: $ 2 S, o v p <br /> Proposed Use of Building:/ teALs A £ t.._' -4, &e.."Ir Heat Source: .121.Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 0Eommercial El Industrial <br /> Type of Project: ❑New ❑Addition g(Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> .sts II QA.!-1,Io•r 0.-. 'nC=, Pope- c (d <br /> Lti, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIO PLUMBING PERMIT APPLICATION ' _...---"-- <br /> Type <br /> ../-'"-- <br /> Type of Project: _New _ Addn _Alteration -epair Type of Project: New _Addn 'Alteration pair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of st of Fixtures <br /> Fixtures Fixture - Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump i Toilet B ow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub rinal <br /> Gas Piping Boiler / Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes ► er Hookups Other: Clothes Wash Medical Gas <br /> Rangy- Hood Water He Other: <br /> aust Fan Sink( ice/Bar/Mop/etc.) Other: <br /> SPRINKLER f SUPPRESSION SYSTEM <br /> 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 /> /"- /0/7 /g City of Everett Official Use Only <br /> ` / PERMIT#......../ -1gA ‘S BIM <br /> — 001 <br /> •caner/Auth• • ed Agent Signature Date (Revised 9/23/2016) I <br /> 1)tAa1w.e ? s-Cit t reit--e", <br />