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S074' cc& <br /> /1111frPERMIT APPLICATION � <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITIONS <br /> t, „ �• CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue,or Bla ck Ink�0i iy:Please) .x.tater PRo4, LITE 1NhF1r RMA11ON .. ... . _< ,,`....a004F. .,, . .'... <br /> PROJECT SITE ADDRESS:a2YP11 Wit U7 3I f EV iii J; WA 8201 PROPERTY TAX#:,Z.9 052000 0o7 dQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> tt _ ..:CONTACT INFOIIII`IIA riAc i..... 3 s' " I EN '. ......,a <br /> OWNER NAME: Rome tZ aftrEi2 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9.411 kIj4G1/tf/'sr ',I/j ,Q7 <br /> CITY �,. v STATE W 4}' zip 9V no I <br /> OWNER PHONE: 25--•;3O Z Z% 1QWNER EMAIL: ren h 1 e,/. 1Oa, T.�I'@boe its ..COI's <br /> CONTRACTOR NAME: /Ot4,t Cafr►f,ey pas F, nG 8154. <br /> CONTRACTOR ADDRESS: STREET /b5P/ HUAI gq # £ �y Q ^� <br /> 44.26":" <br /> ! CITY Lynn wvoo( STATE wA- ZIP `O© 3 7 <br /> CONTRACTOR PHONE: °T.2 74g - fS5 CONTRACTOR EMAIL: reof!/!j /dS iirma kji It.e0/41 <br /> CONTRACTOR LICENSE#(REQUIRED)70/1/61*-019L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) /2-401110 <br /> PRIMARY CONTACT: 0 OWNER lyiCONTRACTOR 0 OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONEMZ5 7q3/553 <br /> 4' atviy\ /joc.e CONTACT EMAIL: p&•241 j 7-5 ei pamovi.-r'', Corti <br /> s gtZietitinBUtt.�1N RMI'I'APP .�ATIQN 3 c .a.L .? .lli . .. .. . <br /> Existing Use of Building. AU/ Contract Price of Work:$ 321-7 5 I •DO <br /> Proposed Use of Building: 54-OP Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ,J SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:2tJew ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ne—co 1 0.e.TAGN'&to j Iron r p .F il,t,l� j S tta &N y 1 2 D,,C 3(O s ROP W p441 <br /> (4'ecwe He 19k - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . MiMEc HANlCAL_PERMIT APP ,KATION +/(,t. L,t P .UtMIBING P ER*:ft oPJ ICA IOC. /A <br /> .mow <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alterati• Repair <br /> #of r#of #of #of <br /> List of Fixtures I List of Fixt es' List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat P •p Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Systems Uni 'eater Bathtub Urinal <br /> Gas Piping s.iler 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/gar/Mop/etc.) Other: <br /> SPR1NKi;*ER/ PPRESTIQI SYSTE-I11 <br /> Chemical 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 Offr a before being authorized under any circums nce.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 corn y ith the State Contractors Law 18.27 RC ap 296.200A WAC. <br /> City of Everett Official Use Only <br /> )1 1/4 _ �1� 3/rs PEI #� Ra( - off r .,. <br /> Owne/Authorized Agent Signature L Date (Revised 9/23/2016) <br />