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• PERMIT APPLICATION. <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> Otlijerr <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ;;: PROJECT SIITE,INFOIRMATION : :: ... . <br /> PROJECT SITE ADDRESS: Ocr Si; Ev,i-c$j tun tahr,PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. .. ;:: <br /> OWNER NAME: tJ� to f" "t5'ItthfrENANT NAME(If Commercial): C(KCAle are 0-34.1 <br /> OWNER MAILING ADDRESS: STREET 4010 Wile" ihie-441 I `fO° <br /> CITY (levat. STATE IN 1 /ZIP 3-^�0V <br /> OWNER PHONE: C Liz ) L16 -/ O OWNER EMAIL thrid) . L4 (CO• co+^^ <br /> CONTRACTOR NAME: -Troy ro -- 6 1pk+e eoni r recd„/ eki ici, J Sewv - <br /> CONTRACTOR ADDRESS: STREET Z 100 19 51 SW � 61c /"SC�q Q�f <br /> CITY I y v)/j g STATE W t ZIP GOO 3W <br /> CONTRACTOR PHONE: CN2) yZZ—2.(-/`t/ CONTRACTOR EMAIL: Troy*c.A r ? e;meit'i,C &I rezei 41, <br /> CONTRACTOR LICENSE#(REQUIRED): CQ�Ot.. PS 89�(L•pi CITY OF EVERETT BUSINESS LICENSE�I#(REQUIRED): I-1+ i//V ' <br /> PRIMARY CONTACT: ligOWNER 0 CONTRACTOR ❑OTHER(Please Specify) . <br /> CONTACT NAME: ?...tt>kord p1'e 'evts CONTACT PHONE: (x,(00 383-7-08 .t:, t <br /> CONTACT EMAIL: 01 i`c.t� CCMGe`ble bee "may ',: co.., <br /> ,; BUILOi1Np PERM.iT APPLIICATJON ::.. ... <br /> Existing Use of Building: ikeee•e#,-1-4.4vvi`A.5 5410"t Contract Price of Work:$ #6448•(1 v <br /> Proposed Use of Building: RWeu)GC''/ e?C ..4Stb v1 Heat Source: ❑Gas (Electric ❑Other <br /> Building Type: I:SFR-Detached ❑SFR-Attached I:Duplex ❑Multi-Family-#of Units: commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel El Repair 341. OSign OSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> c+i l-t'aM. Gt.arx.l>S i. ,(( r'e t'r ,, (3 ewtolt$k <br /> ,0�.,,�o Iti+oh - of �- r 6Jac <br /> o.•3Qj( 6 eE -k- r S(-4.14e-S O 1.1140 0 q 6-0 , Me Out"Im`.43) eteckf c-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Or w1e.CXNct.w%e l ct"48e'S <br /> MEE±HANIO.AL PERMIT APPLIC ATION:: PLUMBIING:!ERMIT APPLICATI©N <br /> Type of Project: New _ Addn _.Alteration Repair Type of Project: _New Addn Alteration Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :SPRINKLER/:SUPPRESSION SYSTEM <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.1 am the owner,or 1 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 /> ,..-7'-46.01111--------1."110116, 11111.° 210/1 & PERMIT#blit„02A0O <br /> Owner/Authorized ••-nt Signature Date (Revised 10/12/2015) -:.. <br /> � fzi <br />