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""--4,, <br /> "--4 PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUM:ING I SIGN /SPRINKLER/DEMOLITION <br /> 1(i;&., <br /> , tia CITY OF EVERETT PERMIT SERVICES <br /> 4' ,f 7 ' <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ' 1 gad irf 8./ )425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Black Only Please) PROJECT SITE 11 FORMATION • <br /> liP OJECT SITE ADDRESS:, .f, I" Z'' • (A9 7 PROPERTY TAX#:ASO4IzP/OA?)g it)O <br /> rr <br /> ;...GAL.for new construction: Short Plat/subdivision Lot No. ,G/ (attach copy of long legal description) <br /> CONTACT INPORfATI;ON' <br /> l2LrW ER NAME: G TENANT NAME(If Commercial): <br /> [;OWNER MAILING ADDRESS: STREET /2..D,S /30 742 sr. ,Se• 40 A <br /> II CITY t (-/ / STATE L/ ZIP /d2 <br /> li <br /> IlOWNER 1 42$�/^ .cf-/ OWNER EMAIL: <br /> IlCONTRA.0 T OR NAME: 5e4-77 Ge- Ate/ /9/Y /T yfrt7g /0A/ GG C <br /> CONTRACTOR OR ADDRESS: STREET ( f�" 450 rz cp.-, Se - ,4- <br /> CITY mil/ 972 er I r/r/7 STATE ZIP?��/ C n <br /> �(J 4-7 <br /> f ICONTRACTOR PHONE: .2 f r-5V/ -6 ,.-;/ CONTRACTOR EMAIL: 5 DA f�MCS e,,,„„ G r C , <br /> ir— <br /> (CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> 1'PRiiillARY CONTACT: 51 OWNER CONTRACTOR f8,OTHER(Please Specify) 4 t9/t/ of GtfO D 6 <br /> jI• <br /> C NAME: CONTACT PHONE: <br /> M <br /> /fMlai G -(- - CONTACT EMAIL: C. y!� 7 Czitpoi if . c n <br /> BUILDING.PERMIT APPLICATION <br /> II---- <br /> 4_ — <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 1,2 2- A-'7IA1 t75 Heat Source: I2Mas ❑Electric ❑Other <br /> Building Type: ?DSFR-Detached :ISM-Attached ❑Duplex EiMulti-Family-#of Units: I a✓' ❑Commercial ❑Industrial <br /> ;'Type of Project: igNew DAddition ❑Remodel El Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> sw <br /> ;IIDE'.S:_:RiPTION OF WORK: <br /> j} Goit i 7U�d�, 6 5 e,-- - <br /> a wIv l tc,/,&--ri, - . <br /> iJ <br /> i ASSOCIATED BUILDING PERMIT#(if applicable): <br /> F MECHMICAL PERMIT APPLICATION: PLUMBING PERMIT APPLICATION <br /> ITy f2 of Project: New _ Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of + List of Fixtures #of List of Fixtures #of It List of Fixtures #of List of Fixtures <br /> !!Fixtures 1 Fixtures Fixtures I Fixtures <br /> i - INC-Air Handling Units Heat Pump _ 3 IToilet Backflow Preventer(Inside Bldg) <br /> lw Forced Air Systems 4 Unit Heater 2.„_Bathtub Urinal <br /> 11 Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration - � Shower Floor Drain <br /> T -, Gas Fireplaceri_ - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> il —iGas Range Ducting _ Li Dishwasher Roof Drains <br /> I-- -( (Clothes Dryer Hookups Other: 4 Clothes Washer Medical Gas <br /> L1 Range Hood - ^ Water Heater Other: <br /> is ,Exhaust Fan -- !Sink(Service/Bar/Mop/etc.) Other: <br /> I 11 <br /> IL . SPRETI ILER/SUPPRESSION SYSTEM <br /> y j 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 / 1 PERMIT# - 1 D 1 - a t <br /> Ov ner/Authorized Agent Signature Da e (Revised 9/23/2016) �� <br />