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PERMIT APPLICATI(X <br /> BUILDING 1 i EGHANICAL I PLUMBING I 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 wwvr.everettwa.gov/permits <br /> ( as .gip IAB I _➢ell ..® Ujj P9 0 PROJECT 59TE 9N l t ld II R9. :- <br /> PROJECT SITE ADDRESS: FL' ( PROPERTY TAX M <br /> LEGAL for new construction: Short Plat/subdivlsion Lot No. (attach dopy of long legal description) <br /> OWNERNAME- EtLj15 ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ,TREES j y /W <br /> CITY 4t JJC STATE CJi+ ZJP G.-ly <br /> OWNER PHON CjOWNER EMAIL: /v <br /> CONTRACTOR NAME: Ea=i Y, a 1`'t - <br /> CONTRACTOR ADDRESS: STREET 2_t Z© A d— <br /> CITY STATE L DA zip <br /> CONTRACTOR PHONE: +fZS <br /> EE <br /> - (( CONTRACTOR EMAIL.CONTRACTOR LICENSE#(REQiiIRECITY OF EVERETT BUSINESS LICENSE#(REQUIRED):PRIMARY CONTACT: EI OWNER CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: NZS ,jQ1 _0-74z <br /> CONTACT EMAIL: <br /> ;.s <br /> ,BUILQING:IP RMIT;A,PPLICATi®N <br /> Existing Use of Building: Contract Price of Work-$ <br /> Proosed Use 9f Building: Heat Source: Gas ❑Electric ❑Other _ <br /> Building Type: SFR-Detached ❑SFR Attached ODuplex OMulti-Family-#of Units: ❑Commercial Oindustriat <br /> Type of Project: ONew DAddition ❑Remodel pair E1T.I. []Sign E(Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK; 0- A &4- <br /> J <br /> ASSOCIATED 13UILDING PERMIT#(if applicable): <br /> :..tVtECI'1 I dIC iI::Q)c1lilVi9TAOP'CldATI®1V' InQ tlBAfll¢9 P)E i6 9 :APt? li TKI <br /> Type of Project: _New Addn Alteration _Repair TypeofProject: _,New Addn A[ter#of #°f <br /> Fixtures List of Fixtures Fixtures List of Fbdures Fixtures List of Ffxfures Fixfures <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 HeaterRefrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dfsposal Grease Trap <br /> Gas Range Ducting Dishwasher 1R001 Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood _ Water Heater Other: <br /> Exhaust an Sink(ServicelBarlMop/efc.) Other: <br /> SPRINKLER./ Ullls?l Qt1E 1(®6 . ti'a lEilry,.. <br /> Number of Heads <br /> ACKNOWLEDGEMENT']have reviewed this applicaBon and confirm the Information contained herein/s five and correct. Work done pursuant to this permit must comply wlth <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 circurnstance 1 am the owner,or t 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 I a27 RCW and 296.200A WAC. <br /> Clfy of Everett Official Use Only <br /> PERMIT <br /> Owner/A thorized Xant Signature Date (Revised 5/20/2096) <br />