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IIII III PERMIT APPLICATION <br /> BUILDIN&3`UIECHANICAL/ PLUMBING /SIGN/UI I�INKLER/ DEMOLITION <br /> "IPIP.I.:;---.A CITY OF EVERETT PERMIT SERVICES <br /> ���� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: // 02 0 ry-6ic%ReAl fl)At7 C,➢PROPERTY TAX#: <br /> 4 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1© t4 P 7_43 DGti,r721- Lt_c TENANT NAME(If Commercial): *7- 7-7-0 A4,4-Ag-'-r <br /> OWNER MAILING ADDRESS: STREET /.3f30 <C2 KD ,4j : Cil <br /> CITY /pn ii KJ Lr -r, STATE 4...k/k/a. ZIP 9C)9 <br /> Z i <br /> OWNER PHONE: 37z- ol- OWNER EMAIL: <br /> CONTRACTOR NAME: $ AD is-i-2(Jt7 ,1) <br /> CONTRACTOR ADDRESS: STREET /VD? t9.-ryk. ,4 V. cj c^�,.�}r�� <br /> CITY r � Q /) STATE IVA ZIP/C t2 <br /> CONTRACTOR PHONE: `2 77/ /v, �(--/_ /9, CONTRACTOR EMAIL:A�r ®)Aivp 7�H . a'y,-i <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ArCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 'ref/ CONTACT <br /> PHONE: (4M--J '7 71 // 9 2_. <br /> /y CONTACT EMAIL: A,,vpy 7----,././ 2 A r-/ , , 69 Af <br /> BUILDING PERMIT APPLICATION � <br /> Existing Use of Building: Contract Price of Work:$ /6/CO C� <br /> Proposed Use of Building: My - 7-- Heat Source: gGas Ntglectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: , Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑F2emodel DRepair RT.!. ❑Sign DSprinkler ❑Demolition/ ❑Change of Use <br /> DESCRIPTION OF WORK: F,11-9A/ Cr- PiV r H w® /V p I P CoAirt•-7----�4DA-f 7?/ <br /> r.r2.avr PIAS /r(iS )70- - 03 ? ) <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 #°f List of Fixtures #of List of Fixtures #°f 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 /> Chemical or Water 1 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 /> Op.......c/bilscitv <br /> 03 PERMIT r$D g-O r' !— <br /> Owner/Authorized Agent S nature Date (Revised 9/23/2016) <br />