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OLT PERMIT APPLICATION
<br /> BUILDINI�, MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> 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 www.everettwa.gov/perrnits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: :24;14 7/41''l6 p II. tr ; iSd ` ' PROPERTY TAX#: 41-1. offal 6P 7,,,,
<br /> LEGAL for new construction: Short Plat/subdivision q I I~6ht C) Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: P. pat12.T (0,;..{4. ,jp;CO*amt TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2.17.1„ 7,4,"f t-tir
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<br /> ITa";✓�..��'SIT r 1 STATE W�• ZIP q 6v);
<br /> OWNER PHONE: • a , `'� °d OWNER EMAIL: P-'�*4.1: A c4C#;(s,A boor ' DCN`)
<br /> CONTRACTOR NAME: EA0,:g;,t,taZy' `,,y
<br /> CONTRACTOR ADDRESS: STREET �r (.p I NI ft.14101 ra: ;tl r°:
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<br /> 1 CITY a/I'1SJi404ir STATE WZIP el4no
<br /> CONTRACTOR PHONE: 'G Z^a, '; , 5 SR CONTRACTOR EMAIL: 01`. 7/Ith4
<br /> CONTRACTOR LICENSE#(REQUIRED): )Aa` s %r "�htCITY OF EVERETT BUSINESS UCENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR g OTHER(Please Specify) P 1. i�1 P -1- 01-5102.W
<br /> CONTACT NAME: t: r„Ir,,rr q 04/A CONTACT PHONE: „/Z5 �,, / /(,gyp
<br /> CONTACT EMAIL: Rpi.�l l"i,,°ra' s,yi;eeve4t4,011'6€,,1",7'.�
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Sr- Contract Price of Work:$ 77-'cP`+ Toy
<br /> Proposed Use of Building: ` ;F Heat Source: E3bas ❑Electric ❑Other
<br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New WAddition %Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> 'K 'U,:,r�s,I la„ ',t4 p ',x{°4'p +Tal �i,;i?'t;'4d :4 04 iiifpc I T T2/4,1,s AFS"f¢ 4410/144,,*P. .6�°i.li t,"7; ,)
<br /> ;6'4/4 4 ' 1'„f d{-`e�'`+!r�!=� ,i',7 N;i:: t',.4 y;. l oi4 f►R6.p s . .`7'}D 1�a`i gsk�. 4th E� -.i ieki
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New ,ti Addn ,Alteration Repair Type of Project: _New `4Addn 4Alteration _Repair
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Flxtu es List of Fixtures Fif
<br /> ero List of Fixtures
<br /> A/C-Air Handling Units Heat Pump tpl Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater � Bathtub Urinal
<br /> Gas Piping Boiler S. Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration ,, Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> 1 Gas Range Ducting Dishwasher Roof Drains
<br /> / Clothes Dryer Hookups / Other: I Clothes Washer Medical Gas _
<br /> / Range Hood Water Heater Other:
<br /> ,/, Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Number 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 h he State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT# L DS- V `I
<br /> •caner/Authorized Agent Signature Date (Revised 5/20/2016)
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