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PERMIT APPLICATION <br /> BUILDING ECHANICAL I PLUMBING I SIGN i iNKLER I DEMOLITION <br /> /IP.1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-6810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ",{ 1Ni 7, h P-:,-' +° iaRO.liaECCuSITE 1W oRIVIAT'ION <br /> PROJECT SiTE ADDRESS: �•- `i j k.+c o PROPERTY TAX#: n( ...; 0142 (� 10 co <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;'•.`.;;• i- r 1 !,r F r'R a ,CGNTACdT iN ORNIATIOItI_-ter 34�� ,- - t. "s. - <br /> OWNER NAME: 5-}ie ZV vela. TENANT NAME(If Commercial): e \ ((? C)C.11-A <br /> OWNER MAILING ADDRESS: sTrieEr D0221 1{L}41" Qk0 e S <br /> crrY U(ice t STATE (V 0 ZIP 1 <br /> OWNER PHONE: 20-td- -12)(12 - (Pt-135 OWNER EMAIL: 31-elle..(:')t t.(1;+e..,{- -(rJr1 L':J:1 "'1A:_.,I1�.'I,C�/‘ <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA T NAME': j CONTACT PHONE: (Z0(1,:,) 37-1 -;:-)2:-7 ). t <br /> ✓1 , y 1t!'AA-\ \i1,ti., (/'lL- , A3'Mtii4 MiyaL-� CONTACT EMAiL: 1�`1 '0 ; 3,f GA'it F0'I.�Ccl iii .CO vilk. <br /> .t <br /> `' gli� �UftG016G, ERNIITiAPPG1GATfO0:: :::.`:;'.... :, :_-..: <br /> Existing Use of Building: U)Ck4r. QTA QeryY1 k Contract Price of Work:$ <br /> Proposed Use of Building: Q W‘(olLt9tit i is xa iG Heat Source: ❑Gas ❑Electric ❑Other _ <br /> Building Type: ❑SFR-Detached ❑SFR- ched ❑Duplex ❑Multi-Famlly-#of Units: jirCommercial ❑Industrial <br /> Type of Project ❑New DAddition ❑Remodel ❑Repair ET.I. figign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (� <br /> \2 5 AA\ess Sc.cew5 S o�(1Ve55 kCD OJer 1C d:%b� d W ` <br /> .��� O Ork3 Z0c) 5-}a-Ante55 Wo (>0,aobod.t�, WG�-Afl3e,� C,v�- Ov . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> N1EcHAN)cd#L`-'',PERMiT:APP_LLCATIOM;.;':. = -PLUWVIBING PERMIT APPLICATION._ <br /> Type of Project: _ New Addn Alteration Repair Type of Project: _New _Addn Alteration Repair <br /> #of List of Fixtures List of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures , Fixtures <br /> _ AIC-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 Dra'n <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 /> ' 'rSPRINbCLER%::SUPPRESSION SYSTEM. " r, <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 295,200A WAC. <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> Owner/A prized Agent stu e Dat (Revised 10V12/2015) <br />