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PERMIT APPLICATIOfV <br /> �UIL.DIM1I�ECHANICAL/PLUMBING/StGN/ ' �IiVKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC� <br /> � 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881 D � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permi#s <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATIOW <br /> PROJECT SITE ADDRESS: l O O y' f/,,2-�I� St, �_�. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INEORMATION <br /> OWNER NAME: � c� .�") � r? �. � L TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: srReEr ¢/ 'j /�o f`j�II C�e•'��f (�J � <br /> �� 1%��h e %� sTA-� w.� Z�P y,� �� � <br /> t�WNER PHONE: 'f� � -7� 3 '� S'1� OWNER EMAIL: L a r:^ /� � r e�,;- �cz�7 v Y-`r��5�c C� •'" <br /> CONTRACTOR NAME; To G;P C� ..� 7 G � Z =���� �I u i^''+ °' " ''� C�a��k c.�: � L L �- <br /> CONTRACTOR ADDRESS: sTReFr � / � �� S�, s_�. <br /> ��,,, ��,�/ I 57'ATE �.,1.A Z�P 98 o r � <br /> COIVTRACTOR PHONE: �'o� .�� �, ,�� �-c� �1O l CONTRACTOR EMAIL: �C , ���c7 i1/�'/�cz� 6��n � ,��;/�.cc� <br /> CONTRACTOR LICENSE#(REQUIRED): Z,j.�;NJ��('j�' NC,Z` CITY OP EVERETT BUSINESS LICENSE#(REQUIRED): U S �� �9 <br /> PRIMARY CONTACT: ❑OWNER ��ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �C,�� �'� ` Gh��� CONTACT PHONE: ��� e ,,� � � �i v ,,� e <br /> CONTACT EMAIL: �-1 .�`-- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of W :$ <br /> Proposed Use of Building: Heat Source: ❑Gas <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� C�D ��G � i.�(X. e r- I r �� �+ � �{" 5 v w'� °' vOL�v�' S '�' "�.^_`,..^ <br /> fr� �,c � : � � i3io 3} ac� �3, 3o �� t � �-, azv �� 3o �f <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <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 Fixfures #�f Lisf of Fixtures #of /�sf of Fixtures #of Lisf of Fixtures <br /> Fixfures Fi�cfures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(UVash 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 Ofher: Clothes Washer Medical Gas <br /> Range Hood Water Heater P ;� Other: S /e r��,v�r � �� <br /> Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM. <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMElVT.�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,stafe,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 /> Bui/ding Official Before being authorized under any circumstance./am the owner,or I am authorized by the owner of this properfy to perform the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC <br /> City of Everett Otficial Use Only <br /> �"� � '_" / 7 T# � "—OlJ <br /> Owner/Authorize�c Agent Signature Date (Revis d 9/23/2016) <br />