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4IETTPERMIT APPLICATIO
<br /> BUILDINC . /IECHANICAL / PLUMBING / SIGN f 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION,/
<br /> PROJECT SITE ADDRESS: S'17 Lar �t,/c&r , Z3/4 ,f6� IQ j PROPERTY TAX#:c5/SCr i 9c
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: t7 T S TENANT NAME (If Commercial): GS
<br /> OWNER MAILING ADDRESS: STREET £( E`/,'c 7 ,A, 1.1/, .g,,,,' 1 D',
<br /> CITY �:17`6,/ W�J'�STATE ZIP 9 8 Y / 9
<br /> OWNER PHONE: 2c — 2-1 6 — L-/-9' 6 OWNER EMAIL: r—dc..v :s r wi r9rag p, torr,
<br /> CONTRACTOR NAME: Patriot Fire Protection, Inc. ;�r f O — O �
<br /> CONTRACTOR ADDRESS: STREET 27±07_zath_Av_e_E
<br /> CITY Tacoma STATE WA ZIP 98424
<br /> CONTRACTOR PHONE: 253-926-2290 CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): PPPPPPATAFP0ggC)F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024694
<br /> PRIMARY CONTACT: ❑ OWNER RI CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Z5 3 - 92‘ - ZZ 90O
<br /> ,r'ej r ` CONTACT EMAIL:
<br /> J«fwd, i„,ti,,r Qpc..rr:ar_F-:r.e_.c„,r,„,
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: be-r,'cr_.$ c� (1:7 4, in .zc.ref) Contract Price of Work: $ ;r�2 7i __
<br /> Proposed Use of Building: c4--Pr� .-k �.e (1,'71/1.4" /lcoZc.r 'j Heat Source: ❑ electric lectric�� ❑Other
<br /> ❑
<br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#ofI�J
<br /> Units: C;ommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair YT I. ❑Sign 4lOSpririkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: /�
<br /> sp r,m ,./6..E.5 .r..c., r r ,,,,,,,,t4. c...,v,,,,,,rs„,
<br /> / h ce
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: QNew Q Addn IiAlteration FiRepair Type of Project: QNew UAddn QAlteration Repair
<br /> #of List of Fixtures #of List of Fixtures #of #of
<br /> List of Fixtures 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 /> / 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 with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Eveerreett Official Use Only
<br /> .‘,.eci ,i:,t k 1,--7
<br /> 5,//-'-7-<. r/-2 -' PERMI #1k4j.clr—‘
<br /> b_... () n
<br /> Ow /Authorized Agent Signature Date (Revised 5/20/2016)
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