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PERMIT APPLICATION <br /> a BUILDING / MECHANICAL I PLUMBING I 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS(/ J R 1 PROPERTY TAX#: <br /> �S `- i -,41; <br /> LEGAL for new construction: Short Plat/subdivision 444$ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6ti.la Ad,,,,,‘,../ CJc j;„4,4„sh z-G ,TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I SCS 9 !G itce.werb 4 577, <br /> y <br /> CIN F r4r t STATE ,j '- ZIP 9p�U J <br /> OWNER PHONE: Z- ---Z- --- Q OWNER EMAIL: Loki ,� +�60�p/Il.�y &1 r5 p.p.147.4 ,ca,:00, . <br /> CONTRACTOR NAME: ��ivi,v/L fr& 1€/u // c I Z,.. 1, -_ <br /> G �`.� Ni <br /> CONTRACTOR ADDRESS: STREET 7„//6) /14 u‘,44,,,,,,, ST. <br /> CIN F veKe fL STATE 1j(/is ZIP 9,2, 3 <br /> CONTRACTOR PHONE:42 5 317, os. 5-f CONTRACTOR EMAIL: ci,„.lL & d`yi.,,Gt, G. e6w4.7 <br /> CONTRACTOR LICENSE#(REQUIRED): (yLYV LP&C.975-p .... CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):A365-3 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME:‘16 <br /> /JI CONTACT PHONE: 4,7/5--..5-0g*- 3 75 <br /> /_)a& `tG0alrs''/ CONTACT EMAIL: eh/e. - C r„,.��G/AG . 6e,..4-2BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: &C .*Y Le"--- Contract Price of Work:$ 4II' GC--t, — <br /> Proposed Use of Building: orage�e---- Heat Source: DGas /Electric DOther <br /> Building Type: DSFR-Detached DSFR-Attached DDuplex ❑Multi-Family-#of Units: commercial ❑Industrial <br /> Type of Project: ❑New DAddition gRemodel DRepair DTI. ❑Sign ❑Sprinkler DDemolition DChange of Use <br /> — <br /> DESCRIPTION OF WORK: �� i_ /4�f �� <br /> lolu E t c.1( 6-Y 5r1;7 //��'kie//• Aid/ A / <br /> -2 t)c 5 `P-.- /t e W v-iF l'r �'j�4f 6,g , <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 /> # List of Fixtures #of List of Fixt #of List of Fixtures #of List of Fixtures <br /> Fixture Fixtures Fixtures Fixtures <br /> ot. Air Handling Units / He. . p Toilet Backflow Preventer(Inside Bldg) <br /> Force. stems 'snit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firepla - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas : .e Ducting Dishwasher Roof Drains <br /> ' . es Dryer Hookups • her: 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 WAG. <br /> City of( O - <br /> Everett Official Use Only( <br /> AP /' - / .4111. PERMIT#. �W� <br /> O ¶ honze. •g nt Signa ure Date (Revised 10/12/2015) 1h <br />