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MINI
<br /> • PERMIT APPLICATIO
<br /> 12
<br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN / PRINKLER/ 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 ,p
<br /> PROJECT SITE ADDRESS:/('?XX 5Ti 4 7 25 ✓ eL' 0,4,j PROPERTY TAX#:,q C)?Ol 4"/r✓(✓DC,�)4!C!7CO .
<br /> LEGAL for new construction: Short Plat/subdivision ,,''O 2 o )86 75(1'D-Z Lot No. 6 (attach copy of long legal description)
<br /> ���� CONTACT INFORMATION
<br /> OWNER NAME:tylli4,.yi/ 42j vet a. 4,4_,,,,,,mGIL4- TENANT BUSINESS NAME(Commercial): /t/7�.
<br /> OWNER MAILING ADDRESS: STREET •-•-?/Y /14l77 <
<br /> CITY ‘v,/ rj� / STATE 4,r ZIP 26
<br /> OWNER PHONE: f2r, ;-i' y ,941;,)-,--) OWNER EMAIL: 4 ' ( L':`/1'.4/4. CL%%7,1
<br /> CONTRACTOR NAME: i�/ /AT
<br /> CONTRACTOR ADDRESS: STREET 4•7j�4 4J�/i1 ,Z�" e'
<br /> CIY T ��1z,�(( f 1, STATE /in ZIP 7ff, ,i
<br /> CONTRACTOR PHONE: tper..&--- g. g/1/Zi CONTRACTOR EMAIL: 'Zif/,4% �,�(7 614)4 f-, ,L- )�
<br /> CONTRACTOR LICENSE#(REQUIRED): P71/jiff . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): e y4:27 �'
<br /> PRIMARY CONTACT: A OWNER 'CONTRACTOR 0 OTHER(Please Specify) r
<br /> CONTACT NAME: CONTACT PHONE: 3/4,eb g, J/3, ‘de/J
<br /> ' 9� 'tee,A'7�� CONTACT EMAIL: j7-/7,f ,,'G?`/� �igt'_ /1".7. te,,l:Zr''h
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: A//- Contract Price of Work:$ /4:,..5 f 0006
<br /> Proposed Use of Building: t�.5 / Heat Source: AGas ❑Electric ❑Other
<br /> BUILDING USE:pSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: New Addition Remodel Repair T.I.❑ Sign Sprinkler Demolition Change of Use
<br /> DESCRIPTION F WORK:
<br /> /✓A) COr ri47/iV J'/ A oZ ,T- D.-✓ Y,C,,✓r ,a7--
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): `/Ofi '(;— 12.U I P , CO
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping BaeRfle Preventer(Inside Bldg) 3 Shower,Tub,or Combo
<br /> r / Gas Ran ( Clothes Was Sink-Commercial(3-comp,prep,floor)
<br /> l Clothes er f He ump&Ductless Dishwasher Sink-Residential(kit ,bath,bar)
<br /> Duct System odel) efrigeration Drinking Fountain / Sink-Utility ry,mop
<br /> 4j Exhaust Fans(Rest ial) Commercial Ventilation Floor Drain Toi
<br /> Exhaust Hood(Type I) (Not Heat/AC system) 1 Hose Bibb ' I
<br /> Exhaust Hood(Ty Water Heater Interceptor-Grease Waste a ing Repair _
<br /> Exhaust Hoo esidential) -`W pd Stove Interceptor-Sand/Oil Water Service(behn r
<br /> 1 Forc r Systems Other Medical Gas Water Valves or Fixtures
<br /> / Gas Fireplace/Insert/Log _ Roof Drains / Water Heater
<br /> SPRINKLER/ SUPPRESSION SYSTEM Sewa jector or Sump Pump Other:
<br /> Water Suppression System Chemical Suppression System I 1No.of Heads
<br /> 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 I comply with the S ontractors aw 18.27 RCW and 296.200A WAC.
<br /> my
<br /> �,./(,/, . P2-1oZ0 COID
<br /> Owner/Authorized Agent Signature Date (Revised
<br /> 2402-- ZLbZoLk2,41 Q2,1
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