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PERMIT APPLICATICiiv <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FlaX 425-257-8857 �(E)everetteps@everettwa.gov� wv�nv.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECTSITEADDRESS: ;.dj .S�vv,�h ��J� ���u;-i'S �.�,� LJ��Z PROPERTYTAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION � <br /> OWNER NAME: �� � � � TENANT NAME(If Commerciai): --x�� �� <br /> OWNER MAILING ADDRESS: sTReer <br /> (�, �O)( ,��,`,'1 CITY I=�J��,N1 d:,a� STATE L.V� . ZIP ����(.)L �i <br /> OWNER PHONE: �{LS' 7 3 "�;7,� OWNER EMAIL: �'1��.�1��,� I��- h-v� 7. L. . '`��•� C , ��an <br /> _ _ _ <br /> CONTRACTORNAME; (hZIIt — (�C"„�,^r^��MPc�r�v:c ��-L <br /> CONTRACTORADDRES�: srReEr 7,��y ;� � Z �^ � f ��I �I,� � l5 <br /> CITY IF��('✓��^.J�� STATE L�J � ZIP �J,_,O Z-G� <br /> CONTRACTORPHONE: yZ5- S u Z_�.�� j CONTRACTOREMAIL: , � n1�, II< .%M�,'.< �+�1;'v�<°�I .�� ;,�L,-�� a �. <br /> CONTRACTOR LICENSE#(REQUIRED): �"Y�G `� ., {v� G;�n �.i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (�`�,�.S� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z��. ����- 13(� ` <br /> S<<,�-� �����,Z CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t-� Contract Price of Work:$ C C,:� <br /> Proposed Use of Building: S�,;t , Heat Source: ❑Gas `Electric ❑Other <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 ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A'n� ,�,s ��� �4���p�MF R�� �xN,��S} ��N� +� {7aDS A�J iZ�;� ,^�j <br /> �l,L �,r� �5�,2� �•s.� :��� - S�n;l7 �N� l�-2.�v,��v <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 /> #�f List of Fixtures #�f List of Fixtures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fiutures Fixtures Fixfures <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: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> S Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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 permif 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 fhis property to pertorm the work for which applicafion is made, <br /> and 1 comply with tire State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Offrcral Use Only <br /> S C,� � PERM, # ��� ��� I <br /> � � <br /> � � <br /> Owner(Authorized Agent Signature Date (Revised 5/20/2096) � <br /> ' y <br />