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PERMIT APPLICATION? <br /> (g-n- BUILDING / MECHANICAL/ PLUMBING / SIGN I SPRINKLER/ 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: J4/5- J,1"t.' <r ctJ('V/e,Rir✓1 W PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (1 e i2u'- 1 CC(l i 4fK TENANT NAME(If Commercial): / ie.i'4at 6 %Y f <br /> OWNER MAILING ADDRESS: STREET 10/ �iL'c t7- ti-VE: if.) j,5 C,r /y <br /> CITY 5C�"-L' STATE OA! ZIP 9 6/! l <br /> OWNER PHONE: J� /1 /,, /]OWNER EMAIL: <br /> CONTRACTOR NAME: 'FYI i(, ) y/+17C4-A,i-�X S i=i3 VI L .c <br /> CONTRACTOR ADDRESS: STREET /52' C OP <br /> CITY WI L./VK//.4 7& ) STATE 64 ZIP PO 7 1 4 <br /> CONTRACTOR PHONE: ?j L) - 7/ cu j ei CONTRACTOR EMAIL: •j t9t4.'-rrAk.!R0i`InmK-4 1/t'4. = '" - - 14 <br /> CONTRACTOR LICENSE#(REQUIRED):p / Y) `& J? <br /> / CITY OF EVERETT BUSINESS LICENSE#(REQ 'ED): <br /> PRIMARY CONTACT: ❑ OWNER tgl CONTRACTOR ❑OTHER(Please Specify) ---,- <br /> - <br /> CONTACT'LNAME: /� /� CONTACT PHONE: .8lL9.- S`c1)—17 <br /> .---- <br /> ..\e)5(T Nil;ittqF- l'l CONTACT EMAIL: �i'1/.,•f44 geieimmG'il,C�i� , /t'./-e.,41144.W.e'' •_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: IA;x:20,51-11-(,4 L- , Contract Price of Work: $ ,j I) 4, 2 i-� <br /> Proposed Use of Building: / 2 �7- i"-S'fr�,rg G Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex El Multi-Family--#of Units: ❑Commercial ,gkidustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sin _ ❑Sprinkler-_ ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: sA i c.,..;Tpt. <br /> p�] l c)7 Cdr�)t i-e, 4 b C4 S.0/ C( 311-6-4.'Fj�2 3 ul.,po C-+ <br /> hcPG,,46e- j, 75 0' 5.� �Li<t v 4.7 -?Dr - <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 #°f List of Fixtures #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 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 I No. of Heads I <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 author' _•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 Cont.ctors aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Ire r PERMIT <br /> ' <br /> ._ / 042_ <br /> 0 er/• •rize. • . •.1. Date (Revised 9/23/2016) <br />