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PERMIT APPLICATION <br /> BUILDIN�i IVIECHANICAL / PLUMBING /SIGN /S'rKiNKLER/ DEMOLITION <br /> CITY 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.gov/permits <br /> (Biue or Black lnk Only Please) PROJfCT S1TE INFORMATION <br /> PROJECT SITE ADDRESS: �g �Qy� r1V2 . SE ��ere:�f �'8�1 PROPERTY TAX#: 7J�7Z`T d�,/�O <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Na,I LU12- G(,VI(,� �{JGt. �B(.�Ylesoh TENANT NAME(If Commercial): N � <br /> OWNER MAILING ADDRESS: sTReer 3009 Ge�n VZ SE <br /> CITY �VQ�Y`� STATE VV� ZIP QZQ <br /> OWNERPHONE: I- 25 — 5— 249 OWNEREMAIL: ✓�LL'�Q,�1� • r. bV�'�eSOV1 �'}'�a,l �. (SUrn <br /> CONTRACTOR NAME: G�W V S p '�"YU C��t l pVr <br /> CONTRACTOR ADDRESS: sTREeT � 'LS 5�p <br /> CITY �V[�Q� STATE �'�' ZIP 2,I 3 <br /> CONTRACTOR PHONE: —2 — 2j S✓�`- a CONTRACTOR EMAIL: �y�� �Wl� '�CA Y)�YL(G-11�0 N .(py1 <br /> CONTRACTOR LICENSE#(REQUIRED):GO �,(�j�` 4 Q� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OSS 6� I <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) ]Z SI G' ��IZGNfT�GT <br /> CONTACT NAME: CONTACT PHONE: 2i7�O—Z�-�—S�-�O� <br /> �"L�XR'NI�R.�' �/VL/u�L CONTACTEMAIL: d���Y1GtYK d.{ IY,N Q:IW) P.lO�eyl V1 . �'�1 <br /> BUILDING,PERMIT APPLICATION <br /> Existing Use of Building: S I P�NTI F� s N(��-T• Contract Price of Work:$ -�n�.� <br /> Proposed Use of Building: ( (, �j N "'�. Heat Source: ❑Gas lectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. �Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:���� ���,i�� ��5�✓�� �nft��sh� bc�,Se.y►���/1'r �GC(5 c ►'�� t�� <br /> -�<<uo� �� �5� ��or -i-�� c.rea�� a�e�c�a.�Ee �e a,�f!�c���►�-- �4 s+�� r. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOIV <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of �ist of Fixtures #of List of Fixtures #of Lisf of Fixtures <br /> Fixtures Fixfures Fixtu�es Fixtures <br /> A/C-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 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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,state,and local law. The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in wnting from the <br /> Building Officia/before being authonzed under any circumstance.1 am the owner,or 1 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use On/y <br /> � / _ PERMIT# <br /> \ � � �s < < 1� � �' � <br /> Owner/Authorized Agent Sig ture,�� ��RD LLC Date , (Revised 9/23/2016) , � <br /> ��'� <br /> �....�-- <br /> < � <br />