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01-77PERMIT APPLICATIOI <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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJI0CT Sz Ic,A�DDRF1 • A PROPERTY TAX#: <br /> LEGAL for new construction: Short Pllat/t/subdivision Lot No. (attach copy of long legal description) <br /> ' 1 CONTACT INFORMATION <br /> OWNER NAME: C��,.— W Co Jio1/0 k t_, TENANT NAME(If Commercial): S <br /> OWNER MAILING ADDRESS: STREET r?CFI L2t .,s rt i/ -2_ <br /> cm, ..L��c C. 9J t/( 1 STATE 1--)4----. ` ZIP 5y0 T.7 <br /> OWNER PHONE: S i`j66'72......, (�' OWNERIEMAIL: �TPht 1 a i)<:1.3Gr-i4-t:., . Ce0rv" <br /> CONTRACTOR NAME: f t INt tE C l:(P P C A-L- Co , <br /> CONTRACTOR ADDRESS: STREET n, f� <br /> CIN (le �N t- STATE �7r''`9 4)ZIP g g <br /> CONTRACTOR PHONE: ZS3 7j 72_ 73'7 2 _ CONTRACTOR EMAIL: `(1j ZE IL-,IVC2r"S KL yi/14,PC.tc?vi IC 21 e <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER '%CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: yy CONTACT PHONE: G Sj'j 33'77 7 .`~-2_ <br /> --Oct l I Z0p24Je CONTACT EMAIL: '-g2.a12A-A <br /> : �Ke y144L—cis d.•v,CL-0/ ® ':.-7-2'.z. <br /> , <br /> BUILDING PERMIT APPLICATION I <br /> Existing Use of Building: Contract Price of Work:$ -7 S P D® 0 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached 0 SFR-Attached ❑Duplex 0 Multi-Family-#of Units: 0 Commercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DTI. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> w,'CO--e -F71{ t �L(w(e S'- <br /> �d Cyor-4- L !� cap T P, i z ,s�• <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 /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater I 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 1. Other:?fes Clothes Washer Medical Gas <br /> Range Hood D t,ev-i Water Heater Other: <br /> 1 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 /> ,----Thcs.7-sa <br /> PERMIT# <br /> _. (r4,� <br /> iz <br /> Owner/Autho rrel Agent Signature Date (Revised 10/12/2015) '4( <br />