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1111 0 <br /> 014-77- PERMIT APPLICATION 4 jll I- d 7/5/h <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLMON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,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 Only Please) / PROJECT SiTE INFORMATION `,, <br /> PROJECT SITE ADDRESS: 47p 0 2 S16 +h 5") & Elv'.(-e`1 PROPERTY TAX#: '171 10� �' G1/O2_ <br /> LEGAL for new construction: Short Plat/subdivision f <br /> 3h land Acl'`_s Lot No((attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 7 vjrr lct. 1,Ae_an+ i\f2 War n_e f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4./ 2_ 5 $h L_, <br /> CITY EVe re- . STATE (A) 1\t ZIP 111 ��3 <br /> �/ <br /> OWNER PHONE: Li 2-5j--7(op ( j I OWNER EMAIL: rd S 3 COOT f e_ 0ornefA -}-. --- <br /> CONTRACTOR NAME: fl <br /> CONTRACTOR ADDRESS: STREET g ISLJC> -- oy2 _ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:eRx, A I , a r r r CONTACT PHONE: {it'2_5--T --/l 5 1 <br /> CONTACT EMAIL: r j 5 war xti) 0,0iy\csA54.. <br /> NA_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 1 r)gl2. Parnn t,1 f'Qs)(' Y'tCQ, Contract Price of Work:$ <br /> Proposed Use of Building: _i Heat Source: XGas ❑Electric ❑Other <br /> — <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ,Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION <br /> SCRIPTION OF WORK:, p r Qc Z ba 5-e na� W 1 n d v w S j3 W 1 I'\c�ow we 115 <br /> �l�. �_ � g � r�55 � Io' L <br /> / a do___ , ( fl5- a 01 Krth )orc (c e c. t <br /> to mp-(k.p 3 5-�rn ra r vo i r) bQ 1®w p& atd)oleQ r r- he <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLTCATION PLUMBING PERMIT APPLICATION <br /> :Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair O <br /> #of #of #of <br /> List of Fixtures #of List of Fixtures List of Fixtures List of Fixtures <br /> Fjlxfures Fixtures _ Fixtures Fixtures <br /> r A/C—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> 7 Forced Air Systems Unit Heater Bathtub Urinal <br /> 8 Gas Piping Boiler e 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 Water Heater Other: 1 5cs,.d.0 - jv ,..) <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:J vf��& -W-i7r 1Z2,e7� <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ( No.of Heads <br /> ACKNO WLEDGEM 'i have reviewed this application and confirm the information contained herein is true and correct.Work done o 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 circumstan .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 CW an 296.200A WAC. <br /> ^ 7 City of Evenou nu n„i,. <br /> ` ,,, ,1 7 5 /1 1 PERMIT/' C. 04. co i 7 <br />