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I • <br /> • <br /> (i477 PERM IT APPLiCATION <br /> BUILDING/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 I www.everettwa.gov/permits <br /> (./.4- w DIack Ink®.nly.PIease) • • • PR'!JECT sI,T IP nkkiim`�IOi I •.•. •• • /� <br /> PROJECT SITE ADDRESS: 2 2I I W• & /No MO PROPERTY TAX#: a89,//yoo 200 e9e) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) Z 7 --7y c/y <br /> . • ..CONTACT iNFORMATI-i im . •. . . - • • <br /> OWNER NAME: AC.,Gi66 C4$if— t-o TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f ��" <br /> 2. 2(l( (-1,• & S,�° p/� <br /> CITY' <br /> ��'� .< / STATE i� ZIP G L�20V <br /> OWNER PHONE: OWNER EMAIL: 1 <br /> CONTRACTOR NAME: E 0.CP.6 MAJ 6ri `rd( Cer P 4,61AC.- <br /> CONTRACTOR ADDRESS: STREET `2-1 )�0� �� 1 I A� <br /> C TY 'F:a() -t I 1 STATE (Ai.4- ZIP /C3 / <br /> CONTRACTOR PHONE: 4'2 5 2-5-1--' 114 • 'CONTRACTOR EMAIL: 014 t£S5i14&A . <br /> CONTRAC <br /> TOR LICENSE#REQUIRED): COG12•65S ca.?r 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C1 6-1 ey j . <br /> PRIMARY CONTACT: ❑OWNER I-CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 7 5- -WO <br /> N4iA (,ra.( CONTACT EMAIL: Mvae, cSs,Mcal,a ,e-tvil <br /> .' . BUILDING PERiVHT APPLICATION ' . - . -• • . - <br /> Existing Use of Building: fr 4d°'LU F — iNp it e/A—r Contract Price of Work:$ / ,2Of DOD <br /> Proposed Use of Building: tY <br /> " O e-b114 66 Heat Source: Gas $•Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached EDDuplex ElMulti-Family#of Units: flrommercial ❑industrial <br /> Type of Project: ❑New LklAddition EiRemodel ❑Repair DTI. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: A D 4)6 2 5 -tOAJ ' op t v oh IL) 6 rPI(- /-- ' ri#.) 6 6,4 5 ' <br /> e .a� D° o i�, . t IA.) `16- `(N v �i3s . <br /> �����wtvw� (5 �v�T BSc r!✓G u�co t� ��� � 7 �,� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .4MECHAIII CAL PERIi/IIT'. PPLICATif i M 1 . • • . PLUM EiIN( PEgMIfMITAPPILiCATIOi - <br /> Type of Project: _.New?'� Addn Alteration _Repair ' 1 Type of Project: _New Addn Alteration Repair <br /> °f List of Fixtures I #of List of Fixtures ! of List.of Fixtures #°f List of Fixtures <br /> Fixtures !!!! Fixtures ;Fixtures ' Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bfdg) <br /> • <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 Wafer Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> .aPiVOKLE %4v,iPPitEp0I®4 syp.TEIVI <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 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 /> Cit(y)of Everett Official Use Only <br /> 2 r2 YZoS <br /> . <br /> C2r/AuthOozed Agent Signature Date (Revised 5/20/2016) . ya <br />