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I"Pro4.1,"-A"%/'— PERMIT APPLICATIO <br /> BUILDING/MECHANICAL/PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> N 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /1/8 'ZO STy S tv PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: %-eS( - i �%TT��z.Ycr G 0-0(.)f' TENANT NAME(If Commercial): .-QSx C <br /> OWNER MAILING ADDRESS: STREET H// 441eV reWS:715e. Jliri/.u.E <br /> CITY ei-m • PL,9' J S STATE N Y ZIP /04.437 <br /> OWNER PHONE: 11.2s--.290 - 8106 OWNER EMAIL: '}-0A4. Cto a ['t.psico. C..GM <br /> CONTRACTOR NAME: -St la esti-e- PL-1 Sy 57cois1 /NGS <br /> CONTRACTOR ADDRESS: STREET /O Qom/ Aks,3,TT Aye, 5. <br /> CITY Bug)fyf/,v 4 TO D'J STATE M ZIP S.76-.413 7 <br /> CONTRACTOR PHONE: 6P51- &E-7s V CONTRACTOR EMAIL: lrorc Q 5'/e1,3 lep lisyc+ 0y <br /> CONTRACTOR LICENSE#(REQUIRED):!N 4 LS 1 1 0 e CITY OF EVERETT BUSINESS LICENSE#(REQUIRE :It•.L ;- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) ;;V 1\ ‘b <br /> CONTACT NAME: CONTACT PHONE: /D/g,-' /0 7(� <br /> `Ei oy Sa,4,0tNSoN CONTACT EMAIL: /Gm' s e /e p(7 SYS-1e S.Cd A-7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 0Fi=ir.E/e1-41-A-VHdelSe Contract Price of Work:$ I/6�FOO 3 O 39 7riQ." 1`fv Y <br /> Proposed Use of Building: Of'i?C.E/uw9A 'e/-/ewSE Heat Source: ❑Gas ❑Electric ❑Other noG(-4, <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: NrCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:00.� + div s--i..� se.� ��Rrsr + w���'+�' �d 6l#'- 7', <br /> 0 sS.vrr7-)0,.,. •04— pg y 4/4"...0"-S sG� �irvs:I�+, S�e3rc6 r�i���csl.'S <br /> 5.J6— Saopc cps. wo' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #of List of Fixtures #of List of Fixtures #of 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 /> 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 under any circumstance.1 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 /> I City of Everett Official Use Only <br /> /4-41/ /VAe PE�#1mt 0 — O\9 <br /> Owner/Authorgent Signature 1 Dat (Revised 9/23/2016) <br />