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PERMIT APPLICATIO <br /> BUILDING I MECHANICAL / PLUMBING I SIGN /SPRINKLER / DEMOLITION <br /> '444W ._ <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�12..E i DDRES <br /> :1tt.S� . / qq PROPERTY TAX#: 2 -wz-. <br /> LEGAL for new construction: Short Plat/subdivision 1 Lot No. D(attach copy of long legal description) <br /> CONTACT:INFORMATION <br /> OWNER NAME: J 14048,44 e:z TENANT NAME(If Commercial): 4 .7/44.17 f iY�.f $S <br /> OWNER MAILING ADDRESS:` O STREET 5:A-1/441 , 11,6 77 13 CIZi$ 4.41-1 . Alit._ d. <br /> h ZIP (6/49 <br /> Crit �l�iL`G-- STATE w <br /> OWNER PHONE: 7-06 ffg 2(4,31) OWNER EMAIL: 5CO-ic 0 SCeci et'1 g-iOt'► Z . Givm <br /> CONTRACTOR NAME: A i55 CO -fi 1Vor- -. � C <br /> CONTRACTOR ADDRESS: STREET -34C- 112;'PI AV_✓--, Stir MD /! AA [� <br /> CIN A4.4.44/1,16- STATE (VZIP 7 <br /> CONTRACTOR PHONE: 24041 25O- s"D 0 / CONTRACTOR EMAIL: U NORR LS 6, Icy CO IV `-T. Ijli <br /> CONTRACTOR LICENSE#(REQUIRED): APR 0-Cc.'C•14,67L 1TCITY OF EVERETT BUSINESS LICENSE#(REQUIRED)CI5.`I CO <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ILOTHER(Please Specify) (2-06r l 1)UA.3 ni A/U4 '' <br /> CONTACT NAME: CONTACT PHONE: 2..O ' ?£ 2453D <br /> .� °r CONTACT EMAIL: 6 &5 4 ,l h10,,1 L r 111N <br /> _. ..7NG PERMIT APPLICATION: <br /> . <br /> Existing Use of Building: i ? 4(",f 51-1/0 t a Contract Price of Work:$_ 411317 <br /> Proposed Use of Building: fCTAIi' 51V Di'D Heat Source: RGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: Iommercial 0 Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ,A11.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:_L'1�leiz.10rf.. *fir. it C-0 3 kif9'Y-7 �j 4 l tit 1 at. RA-Diet. T-00 is <br /> 04.7a A-N V -1,-+ 1, 'i1 1~ 1),2y, F-T 1 &W t-L 9i 1? /1-1A 04.•;.* <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION i 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 18.27,4CW and 296.200A WAC. <br /> 5:4City of Everett Official Use Only <br /> , _4• � � �4.--�" 3 • 2.O(b PERMIT S 1 (.1,0 _, <br /> b53 <br /> t w r Authorized Agent Si; ature Oat (Revised 10/12/2015) <br />