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4ETTPERMIT APPLICATION <br /> BUILDING .. ___ECHANICAL / PLUMBING / SIGN ) RINKLER/ 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 Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: , �1 ij Y`0"tai 4/��Z PROPERTY TAX#: 0u9i 2e)'04.)3/ 67e)✓ ev <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �/ CONTACT INFORMATION <br /> OWNER NAME: 7ag 42. 4 I TENANT NAME(If Comrercial): � �- J <br /> OWNER MAILING ADDRESS:// STREET /�/� J � ' � /J Q <br /> CITY ciii.P7,/)/'— STATE N ZIP /g-},9_ <br /> OWNER PHONE: 1 �J/ GJ , L <br /> 7.) ,- MX3 OWNER EMAIL: (--.74d//iC/nr, -E /I„ 6i-pi.-7,2I <br /> CONTRACTOR NAME: 1 <br /> CONTRACTOR ADDRESS: STREET :?ji/ l,(4 7kE, <br /> CITY ,l'i.„,,Ej,. i3-- STATE A'✓i ZIP 7Sf 20' <br /> CONTRACTOR PHONE: 1/)Jj kyr 961..s CONTRACTOR EMAIL: --/-7,0z7/4244,,,c, , - a,1�/L ,C�'i2,/,7 <br /> CONTRACTOR LICENSE#(REQUIRED):(L /''////y ;F 5 5 '52_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 01/434; 7 <br /> PRIMARY CONTACT: Q OWNER ,E] CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 45 <br /> ,-,.y..,---_ ,883) <br /> D 414; . CONTACT EMAIL: �a'.x4ifj, -And/` CeL,i,t <br /> BUILDING PERMIT APPLICATION . <br /> Existing Use of Building: — AIM -_ Contract Price of Work:$ .3 7 y�ti? ;` <br /> Proposed Use of Building: , 1/4 Heat Source: Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached NtSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project. R.New ❑Addition DRemodel El Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C.� � <br /> 7.-1-/ZiZ i/ti�`N/6/ /✓ ®/ 4 �/q v/q 61,14 / /vr-,/,/°-_- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: A New _ Addn Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units I Heat Pump 1/ Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler jl Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration . Shower Floor Drain <br /> 2 Gas Fireplace Wood Stove / Kitchen Sink& Disposal Grease Trap <br /> y Gas Range Ducting / Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> i Range Hood Water Heater Other: <br /> g; Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ 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 Ia -granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Build'ng Official before being-.hot'e•under any circumstance. I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the St. -Coy: ors 1:. RCW and 296.200A WAC. <br /> 9r 1� City of Everett Official Use Only <br /> PERMI <br /> 'Ny <br /> �,. . _ Mate/4:)/ <br /> . 09 -�L--C <br /> Owner/Authorized Agent Signature �' aD te/ (Revised / <br /> 23/211 G) <br /> 4. <br />