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0 <br /> ' -,, A\ C3MI DIN&. I iltiE :H 'yNk;ill.... / 61 Lk.ftJ E. NP I SIGN I :.WV-I4` KL.ER I [D[;.:11Iaa;::)1...WON <br /> 4:,._,_. CI-IY(.)f=E_VI=:RF�i-f�Pf=RMI I SF_f"ZVICES <br /> F !/ 3200 CEDAR S I REE r,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink telly Please) PROJECT u' SITE IE.9FORMA u"IONI'PROJECT SITE ADDRESS:/o 7Z s" O. /9 __ <br /> 1'7 41-t . cf, 6 PROPERTY TAX#: 2V e,I"2 Zo3 41.oc-j) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) _I <br /> CONTACT INFORMATION <br /> OWNER NAME: j / #V / ti//Jj ¢ v4,0fi,,'a3 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /634 J A- 71t c/7/1 a.e7. <br /> CITY LL.-01,v STATES j/Li A' LIP ?goo <br /> OWNER PHONE: - OWNER EMAIL: t t r t gt tvi'l t'-'12":.) e pul 4 t.1. C--47.1 <br /> (CONTRACTOR NAME: T , _10. <br /> !CONTRACTOR ADDRESS: STREET <br /> I <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> 'CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> 'PRIMARY CONTACT: ❑OWNER CICONTRACTOR :' STHER(Please Specify) h-QZ J-4 ( T T T - <br /> !CONTACT NAME: 1-2..o5,r' L]"-A-.te,A,esS 4 t.,4 CONTACT PHONE: C4 t5-) 2 S Z - '2, f s.3 <br /> CONTACT EMAIL: r-. <br /> �1�. �L ht 1 `7�C"t'��.�-- s s @ 'L-T(i-c,,.-c1...ft.ci--ci,rt <br /> . <br /> •c a.i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S t h.- be tr e-L'i'of-e H t„ r. _ Contract Price of Work:$ <br /> Proposed Use of Building: T o ....N H o &A Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached �tiFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> o PituroirI". Il_ vki 17 •T'ow & Yta 4.g4E—" C'et f 1.I. ,(., <br /> CA----I ( J Ih t v 1 b 14-L_ r --a an (-me V Id L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): j A ,- ,,t. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION_ <br /> Type of Project: New Addn _Alteration Repair Type of Project: New _Addn Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump 2 Toilet . Backflow Preventer(Inside Bldg) <br /> Forced Air Systems / Unit Heater _-Bathtub —Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) —Drinking Fountain <br /> I Water Heater Refrigeration MM.Shower —Floor Drain <br /> / Gas Fireplace Wood Stove mum Kitchen Sink&Disposal —Grease Trap <br /> Gas Range ; Ducting Num Dishwasher —Roof Drains <br /> / <br /> Clothes Dryer Hookups Others _ E 'Clothes Washer '—Medical Gas <br /> , / Range Hood Ill 'Water Heater _Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.)—Other: <br /> SPRINKLER/SUPPRESSION SYSTEM =MI <br /> Chemical or Water 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 tinder 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 Everett Official Use Only <br /> PERMIT# <br /> (\ GC—, - - <br /> Owner/Aut orized Agent Signatu-e Date (Revised 9/23/2016) <br />