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PERMIT APPLICATION <br /> f BUILDING ECHANICAL/ PLUMBING / SIGN / RINKLER/ DEMOLITION <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (Biue or Black Ink Only Piease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � �j L:� i d%�� i� 1�1� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �� � L �'v �-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srneer 3�5' /-/�:,Q.-��r:� r2i� <br /> cirv �1ri,�`� STATE �./.� ziP R.�203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �D �//-�S�N %�l�✓;�y1 P�ii`,4 /n.Cr <br /> CONTRACTORADDRESS: s�eEr �9 3 -7 U %�-�,-» /�,i� rvG <br /> CfIY ��L �tiCa �ZN STATE L,���- ZIP l ZZ� <br /> CONTRACTORPHONE: .3E�D - y U 3 � �r 6Z CONTRACTOREMAIL: �U�i.�Sc%:.���C������3;�.-�i�� r c���4,c.�v.� <br /> CONTRACTOR LICENSE#(REQUIRED): �c:/�i,.�,o� Z 7 l.� L CITY�F EVERETT BUSINESS LICENSE#(REQUIRED): ��O � <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L,C ZS ��p� _3 ;�S- <br /> ��� �Cj/�jin.':�Jv� - �LrY►.S c,i c CONTACT EMAIL: �;, �•n�:�u�-�r�i.�,��/3��-%, i�..- C G� �� .c a%� <br /> BUILDING PERMIT APPLiCAT10N <br /> Existing Use of Building: — Contract Price of Work:$ �.�' 7G��U <br /> Proposed Use of Building: 5 r,2 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-Detached �SFR-Aitached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ,�New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DE5CRIPTION OF WORK: <br /> /N S t�$�� f��C% SlJ�i�vK-w-�2 S'y 5 %rh� i.� .t.�-n v �i:� Cv� �i/ �U N�.����.�S <br /> '� �z� 7v� ��?� Ac'r�. Ni�� �� r� <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: _New Addn _Alteration Repair <br /> #of tist of Fixtures #of List of Fixtures #�f List of Fiutures #of Llst of Fixtures <br /> Fixtures Ffxtures Fixtures Flxtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Soiler 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/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Z(i Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confrrm the information contained herein is true and conect.Work done pursuant to this pemiit must comply with <br /> current federal,state,and Iocal law. The granting of a permit only authorizes app�oved work and no deviations therefrom.Deviations must first be authorized in wri►ing from the <br /> Building Officiat before being authorized under any circumsfance.1 am the owner,or I am authorized by the owner of this property to perform the work for which applicatron is made, <br /> and I comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett O�cial Use Only <br /> PERMIT# �I�Qr.+ ��^ <br /> � ( � ll� �� Gi <br /> O ner/Authorized Agent Signature Date (Revised 5/20/2016) <br /> � � � <br />