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PERMIT APPLICATIOI+ <br /> BUILDIN ,.. .CHANICAL-/.PLUMBING).SIGN.' �INKLERJ DEMOLITION <br /> 'ill.io/4aet:///-- <br /> '''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 I-www everetIwa..gov/permits <br /> (Blue or Black Ink Only Please)�tPROJECT SITE INFORMATION <br /> -PROJECT SITE ADDRESS: I X / t 0,47,,,„ ._,_ A.,,, _ PROPERTY TAX#:6() 1-) 3 3 O 3 CPDG <br /> O?S )® <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal-description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Co rJ t-4-4-(t vnr i f f-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr I I to 01•` c rt 4/t_.._ /{ 1 <br /> civ E v 1,cc 4 STATE 1 A` ZIP (-, ..e)/ <br /> OWNER PHONE: LAD 5 3 s Cj - r `I s 3 /OWNER EMAIL: C'a 1 f r ) 9m4,1 • , ,, <br /> CONTRACTOR NAME: E 2 c-o_ &n. C 61N e t., e +1 r✓vn <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP CONTRACTOR PHONE: �I 3- 5- sA`i —44(17— CONTRACTOR EMAIL: 4 r•c.\'\s -`e enzJ e i t _,-4-- <br /> , y <br /> CONTRACTOR LICENSE"#(REQUIRED): �}f`-'`•` LLZgv 9TY OF EVERETEBUSlNESS"LICENSE )0r)/1 1`"(vl-�\ <br /> . ` I <br /> PRIMARY CONTACT: �pWNER fl CONTRACTOR C7"OTHER(Please Specify) reaif <br /> t,/ <br /> CONTACT NAME: ( \ CONTACT PHONE: r� a 6 f <br /> ifiMMX 64T ' A re a do,e) CONTACT EMAIL: � rY\r i S G U'e_ <br /> BUILDING PERMIT APPLICATION <br /> ` `3 <br /> Existing Use of Building: ( 5 t 17- c Contract Price of Work:$ I.COI OC.O. <br /> Proposed Use of Building: I11 454,Ck)C e el Co 1-Q fthektAeat Source: OGas OElectric ❑Other <br /> Building Type: OSFR-Detached DSFR-Attached 0Duplex DMulti-Family-#of Units: DCommercial °Industrial <br /> Type of Project: ONew addition iliiikgrnod l DRepair OT.I. OSign DSprinklerbed (❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: `l') I-�-t c .� .... .c._. r e G. r c e, --in r „In,is 4...„(... 0.--^1 b 441i oe,....„ ot v.\ a <br /> 6 ta i oc4re,s ti-.. ✓p 9 4r,s, S r;- <)d14-it.. . .. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New _ Atkin =Alteration _Repair Type-of Project: New Atkin Alteration _Repair <br /> #of List of Fixtures #of - List&Fixtures #of List of Fixtures #.of List of Fixtures <br /> Fixtures.. Fixtures - fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 7_ Toilet 13ackflow Preventer(Inside Bldg) <br /> Forced Air Systems 1 Unit Heater 2,-- Bathtub Urinal <br /> Gas Piping Boiler j.. - Lavatory(Wash Basin) Drinking Fountain <br /> r b C„ .VW" Water Heater Refrigeration - v ,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 I 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 therefiam.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,ori am authorized bythe owner of this property to perform the work for which application is made, <br /> and 1 riply with�ate Contractors Law 18:27 RCW and 296.200A WAC. <br /> \) City of Everett Official Use Only <br /> = PERMIT#6 t px)(6, 00_1)Owne d Agent Signature Date (Revised 9723/2016) �/ <br /> n <br />