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�.` PERMIT APPLICATIOI , <br /> BUILDING t 61ECHANICAL/ PLUMBING 1 SIGN l SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98241 <br /> (P)425-257-8810 1 FAX 425-257-6857 1(E)everetteps@everettwa.gov 1 %wv.everettwa.gov/pe€mite <br /> ink Orly �...., ..,, PROJECT Sit <br /> PROJECT SITE ADDRESS: IM�� w' 1"tit Phi e NvA 1PROPERTY TAX#; <br /> LEGAL for new construction: Short Platisubdivision _._..._.. Lot No, ..� tattach copy of long legal description) <br /> 00.. rT !" Arg" <br /> OWNER NAME: pti TENANT NAME of Commercial): <br /> OWNER MAILING ADDRESS: STREET U <br /> CITY STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME 4,1fe V d iliO<- 01,d PA yr <br /> t 11 <br /> CONTRACTOR ADDRESS: STREET W eo t/ <br /> CITY STATE TIP <br /> CONTRACTOR PHONE: 0 CONTRACTOR EMAIL:M �+Mt 1" $'G Ir t <br /> �i <br /> CONTRACTOR LICENSE#j(REQUIRED): UTUN134jA CITY OF EVERETT BUSINESS LICENSE#(REQUtR ).0414J, <br /> PRIMARY CONTACT: D4 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �� ���,� CONTACT PHONE:' <br /> CONTACTEMAIL: <br /> RV <br /> JILDING PERMIT <br /> Existing Use of Building: Contract Price a Wo $ <br /> Proposed Use of Building: Heat Source: OGaS #rim Cather <br /> Buildin Type: C3SFR-Detached CISFR-Attached GDu lex DMulti-Famil -#of Units: OCommercial Clindostrial <br /> Type of Project: ONew 13Addition ❑Remodel ❑Repair C3T.1. ❑Sin 13Sprinkler Mernolition OChan e of Use <br /> DESCRIPTION OF W K: <br /> ASSOCIATED BUILDING PERMIT#(if applicable is <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addis Alteration _Repair Type of Project: ,__,_New _Addis Alteration ____.Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Ffxtures <br /> A/C-Air HandlingUnits Beat Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Soifer Lavator Wash Basin Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Stnk&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Neater Other: <br /> Exhaust Fan ISink(Service/Bar/Mop/etc. Other: <br /> CL <br /> !SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and rorrect. Work done pursuant to this Permit must comply with <br /> current federal,state,and local taw. The granting of a permit only authorizes approved words and no deviations therefrom.Deviations trust'fust he authorized in writing from the <br /> Building Officinal 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 t comply with the State Contractors Law la 27 RCW and 296.200A WAC. <br /> / Otyof Everett Official Use Only <br /> ! O PE 1 T Y t �(0� ---ci l\s <br /> wnertAuthorized Agent Signature Date (Revised 5/2&?016) <br />