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7/20/16 02 : 40PM PDT TRU Mechanical , Inc —> 4252578857 Pg <br /> 3 <br /> PERMIT APPLICATION <br /> PkETT <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA:38201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.evarettvvii.yov/parmits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION _ <br /> PROJECT SITE ADDRESS: 1 3 2 6, 1'1 g r>` $T .S f,,/ PROPERTY TAX#: <br /> LEGAL tar new r•.nnstruatinn• Short Plat/subdivision Lot No. (atrarh ropy of lohg legal desctlptlun) <br /> CONTACT INFORMATION <br /> OWNER NAME: I kyi t_ 0r.d et:4N TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: sTREET f 'ti Z/5. r4 5-7 5 <br /> c7Tr �,.1 gene-ILI' 7 TATF AIA L LI,• 41 ��3 <br /> J <br /> OWNER PHONE: 12/2 5 - J q 5 - 3 724/ OWNER EMAIL: LLL <br /> CONTRACTOR NAME! Tr k I!-h <br /> CONTRACTOR ADDRESS: sracL1 ! zero J j '.7e 7-- ST 4 2- 2 <br /> rlNti,,,J;rl,J, '-itAII, L}r nn ( e-le 7Z <br /> CONTRACTOR PHONE: 112 5 LI Ss/ -'lao i CONTRACTOR EMAIL: ke,, (, ,p Tr 4t re H f. Le.)rill. <br /> CONTRACTOR LICENSE#(RLUUIRLL): Y]1!1'I` I"7`5L\\' 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rr1 ti ill <br /> PRIMARY CONTACT: ❑ OWNER :CONTRACTOR ❑ OTI 1ER(Please Specify) i .._ <br /> CONTACT NAME: //�� f CONTACT PHONE; 2t 4/ 5-3 a1.e�e) j (-K.i 1:970'2- 53-7(e. <br /> I`e <br /> 11 tr ,1N B,,, 1e I CONTACT EMAIL: W t: 'h >� t7r✓ W+ec.Lir' ej <br /> .st,7 re.Y f •• C tJ Pvl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ -'-O 0 [) <br /> Proposed Use of Building: Heal Source: IGas ❑Clectric ❑Other <br /> Building Typo: ❑SFR-.Detached OBER-Attached ❑Duplex ❑Multi-I-amily-#of Units; ©Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodol LIRepair ❑T.I. ❑Sign ❑Sprinkler ❑Oomolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Projoct: Now _ Addn _Alteration _Repair Typo of Project: _New Addn - Alteration Repair <br /> #of #of <br /> PiXturus List of Fixtures Flrtu f List of Fixtures #of List of Fixtures #of list of Fixtures <br /> Fixtures Fixtures <br /> A/C—Alr Handllnp Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Healer Bathtub Urinal <br /> a 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/Map/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM_ _ <br /> !Number of I leads <br /> ACKNOWLEDGEMENT:I have reviowod f1)is uoplicution end confirm the information contained herein Is into rind correct. Work done pursuant to this permit most comply with <br /> currant federal, state,and local law. 1 hu granting of a permit only aolhorixes spprovod work and no duviutions therefmm.Deviations must first bo authur/cvd in writing from the <br /> Building Official before being eutnonzotl undur uny circumstance. I am the owner, orf am authorized by rho OWAur ul ibis property to perform the work for which applicution Is mode, <br /> and 1 comply with the Stnio Contractors Law 18.27 RCW and 296.200A WAG. <br /> Oily of Fveieu Otdicial Usc owe <br /> PERMIT c <br /> !: <br /> 20// ‘ <br /> Owner/Authorized Agent Signature (nate <br /> (Rrtvrattti 5!2012016) <br />