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44-77 PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER/ DEMOLITION <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 /> PROJECT SITE INFO VI4TION'' <br /> PROJECT SITE A DRESS PROPERTY TAX#: <br /> CC) 5s_ � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1'I✓. e pr-6-vele 14 1,4014ert*5 Lt G TENANT NAME(If Commercial):7 �\-}\\EclOCG;•po1 6r"4 <br /> OWNER MAILING ADDRESS: STREET /`1., Z�MG.,\O r1 \._.)--.)C••--`--• <br /> oY11 <br /> CITY J Cc � '�. STATE \ of ZIP Ss 1 a 1.1 Q <br /> OWNER PHONE: 1 -G k°t-SOD- 04 OWNER EMAIL: JC-cr a 1,,•c- vv-. <br /> CONTRACTOR NAME 71_8-ea.\ Zrvy«-=t o c t\C_ <br /> CONTRACTOR ADDRESS: STREET V-{, aA(_,`H^ 5,t- . SU-) <br /> crrY E8Ary'`o1-vas STATE Vv P ZIP CI,TO <br /> CONTRACTOR PHONE: t-VZ-5 CONTRACTOR EMAIL: cA.er.kc,@:ae�‘,+\'t er'.OrStAC-. CoiY� <br /> CONTRACTOR LICENSE#(REQUIRED):-i ►7EAL=.i_0`le(n-DC- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �' J 7,Z <br /> PRIMARY CONTACT: ❑OWNER E CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 7 7 > e g'pZ <br /> 4 CONTACT EMAIL: <br /> 47-��„,s'i 6.1/ 4 G7� 'rk'�F'r`i t'.,f5 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 4:..tcc, tC. C:(, Contract Price of Work: $ =S-, Vic' - - <br /> Proposed Use of Building: (�;r r C/' 5%; Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units. tilCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ZRemodel ❑Repair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -tVve,ro.pn \ o-\j <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 /> 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. 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 /> UC9-0 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />