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PERMIT APPLICATION <br /> BUILDING / IIILvHANICAL / PLUMBING /SIGN / SFCLER/ 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)everettepsCa,)everethva.g,,v 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS, '—.02, � 0 ilPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET ' L'^emV <br /> c,Tv -17a. r <br /> STA rEi <br /> OWNER PHONE: ( OWNER EMAIL: <br /> CONTRACTOR NAME. . ' "� ` Lk <br /> - <br /> CONTRACTOR ADDRESS: srREET <br /> CITU°'} I -5:�7 1C.„ t.-) STATE 71P <br /> CONTRACTOR PHONE: �t^, ; c { '-�� CONTRACTOR EMAIL: 7 �p <br /> jfLt ►t tf :1 Y2� t'�a�Z Yx_ c %jr�2 <br /> CONTRACTOR LICENSE#(REQUIRED}; ( 04y 7 7A y-1 CITY OF EVERETT BUSINESS LICENSE#(REQUIREQ}; <br /> PRIMARY CONTACT: ❑OWNER F :CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME, CONTACT PHONE: LJ - <br /> CONTACT EMAIL:Y G, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building- Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type; FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-tl of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New MAddition ❑Remodel ❑Repair ❑T.I. ❑Sin CIS rinkler ❑Demolition OChan e of Use <br /> DESCRIPTION OF WORK; <br /> T��d 6eca <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: —New Addn O Alteration —Repair Type of Project; New —Addn Alteration <br /> #of — — _Repairllst of Fixtures #at #of <br /> Fixtures Fixturesi <br /> of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> ( A/C-Air Handling Units ump Toilet Backflow Preventer(inside Bid ) <br /> Forced Air Systems eater Bathtub Urinal <br /> Gas Piping Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin 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 /> ICKNOWLEDGEMENT.•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 /> urrent 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 /> Iuilding 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 /> no I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evefett Oficial Use Only <br /> PERMIT M il p � <br /> r 4 <br /> L <br /> 4n r/Autnotized Agent Signature pie (Hevised 91'2 6,16) <br />