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<br /> NOM • PERMIT APPLICATION
<br /> MI
<br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (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: '2)01 ;,; f't1oc,%crec F,Lk2 to CO13,"Z, 1 PROPERTY TAX#:L'10(c Cib L Oco c 0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: aelC tic;w. pc_`re,,,.) TENANT BUSINESS NAME(Commercial): c>•spr..AlSyc, h1$LitV%0
<br /> OWNER MAILING ADDRESS: STREET 35 c L;C 1 c•• 2-1141 ST SIC
<br /> CITY SQ L,r:A is.) STATE t.:+ f) ZIP cA E 2.1 V,
<br /> OWNER PHONE: 141S 33t 3 - r 173 C ,, A nOWNER EMAIL: ry. �1�`t, , S-^res t5. 1caiNt`tb. c-,•✓'-
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<br /> CONTRACTOR NAME: :4212K. CSC�- )
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)5LkOSL
<br /> PRIMARY CONTACT: gOWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: I1LS- 3-A3 3"3310
<br /> ilc.iiEt, F L L e..) CONTACT EMAIL: r.1,1,l q,"lO i`sin t^t c ,A r;.l r �00 l-e?,,,-..
<br /> BUILDING INFORMATION
<br /> __7"7/2- \\ .
<br /> Existing Use of Building: r, o..,c yc S;ti k 0 Contract Price of Work: $ 15 C C . r... ,
<br /> Proposed Use of Building: C SPA"-C:Sjc? S T,i(• 0 Heat Source: ❑Gas RIEI ctric ❑Other,,
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,,,XC mercialt,OAccessory Structure
<br /> Type of Project: ❑New ❑Addition Xtemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: -T( G t� !°^-LSs �THtu r n
<br /> TO '�,�1 �e, c�na„�� �T.-C.
<br /> -, � IS i�i-i�� l?eLee;Ar�:P m 3"1� 1:.. t»��,,C�LIG� '1�:.:,
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<br /> t' 13 ', I i 1S MuvEva i °s-. Ti" iL E.is rtNik. s;ao cTV:-O-c t,;iLL
<br /> '11N4'1 lit SAAS- No- ec,,s 'rA c.tsT- w;u.. (LC(IN A.NI I've- chAAL--
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Count Count Count Count
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry, mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet_
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System 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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> //f� V �, - PE 2 - t _ 2 0 R �� fD l -
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<br /> Owner/?khorized Agent Sig re Date (Revised 10/10/2018) I---�
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