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PERMIT APPLICATION <br /> BUILDING/MECHANICAL./ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> i_ CITY OF EVERETT PERMIT SERVICES <br /> .. '���' � 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everettepsQeverettwa.gov l wvm:everettwa:gov/perrnits <br /> (Flue or Slack Ink Only Please) PROJECT SITE:INFORMATION, <br /> PROJECT SITE ADDRESS: s w wli bCe,i +'' PROPERTY TAX#: 3 ." Chi S"^ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal desotiptiotx} <br /> CONTACT INFORMATION <br /> OWNER NAME., - g i .TENANT NAME(If Commercial): ' ,c t i..- " <br /> OWNER MAILING ADDRESS: sma r tpo aole 3 1,‘01,_. <br /> cv �-u�' -r - - STATE 4.4)4,- ZIP Cie It . <br /> OWNER PHONE is WNER EMAIL: -Gyi9a"3 dL e i .,a <br /> CONTRACTOR NAME:6-1-1...-,„„1/41-4-r„„1/41.4-r F1J . ._ri >r.-1 s L,j-"�� <br /> CONTRACTOR ADDRESS: "IF—Er ille:;14 i"7167— , ,4, <br /> crrr 6,40 dev.4 j,.5i-ti i t STATE ,4„,,J14. zia Is zrie> <br /> ' CONTRACTOR EMAIL: '3tI Ra L-.tffi m <br /> CONTRACTOR PHONE: � �a,� a..."`7 baa; J �- �'`- �! . ' �$ <br /> CONTRACTOR LICENSE#(REQUIRED) rrEP C 3 JS. ^ ..iCITY OF EVERETT BUSINESS LICENSE#(REQUIRED E' 1 51/6 <br /> PRIMARY CONTACT: ;©OWNER. CONTRACTOR Cl OTHER(Please Specify) Y) •e. lib• 02 <br /> CONTACT NAME: CONTACT PHONE: 36,06 ° .: <br /> 1 . `a'1' .V'-'., 8z p CONTACT EMAIL:„_' 4,J -r-f i az€, 1....i. J a e r <br /> BUILDING PERMIT APPLICATION <br /> xisting Use of Building: OPi i 1 /i i„,.. 11541 4-1 4-6,41, Contract Price of Work:$ Z *:r <br /> Proposed Use of Building:. 1-4.-a714-) Fad Gocai. -- et Source: CIGas DElectric DOther <br /> Building Type: ©SFR-Detached DSFR-Attached DDuplex DMuiti-Family-#of Units: omtnercial Clindustriai <br /> Type of Project: ❑New EJAddition DRemodel DRepair X.I. CiSign prinkler 0Demolitiion DGhange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED:BUILDING PERMIT#(if applicable). 61 —t:Y: . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:„_•_New Addn 2CA teration, Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures # List of Fixtures of #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 Boller 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 /> J Number of Heads <br /> Cl(WOWLEDGEMENT.:I have reviewed this:application and confirm the Information contefnsdherein is true and correct.Work done pursuentto this permit must comply with <br /> rrren!federal,state,and local law The granting of a permit only authorizes approved work and no deviations therefrom.Deviations roust first be authorized In writing from the <br /> uitding:Official before being authorized under any circumstance.lam the owner,or am authorized by the owner of this properly to perform the work for which application is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 296,200A WAG. <br /> City of Everett Official Use Only <br /> PERMIT <br /> _ice \.4°1(D3—01 9- <br /> O vn uthornzed Agent Signature Date (Revised 5/2 12016) <br /> / <br />