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PERMIT APPLICATIUN <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ 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� wwdd.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT 51TE ADDRESS: �j ��� ��lvin,.� ��/t�, �Vc?r� �r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: l a h �r�e- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr I!U�j /�J , �(�l �� <br /> CITY SC.�Z��l�- STATE /y {� ZIP �/ �� �U,� <br /> OWNER PHONE: �O —�j C� — ;���I'� OWNER EMAIL: <br /> CONTRACTOR NAME, !�/vtJnC�r <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR L�CENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �UWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: � <br /> , <br /> BUILDING PERMIT APPLICATION , � ' <br /> Existing Use of Building: t.z,� �p � Contract Price of Work: �_50 0, O17� <br /> Proposed Use of Building: �e- h orrt� Heat Source: ❑Gas � Q�Electric Other <br /> Building Type: L�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �'� �-f�Commercial ❑Industriai <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / n / / <br /> /��(.���t h i��t r.al�Ir Yz C��S : /-{ �� /1 P��� �v�/ l� S FJ�'�S ,` it�cJ .S R O�t.'c r l/'.x �V P S <br /> / J , J ' / <br /> V�C...7�x /Z.l�..h.lfi"�� V✓/��n'f I —��YY)ML��-% �1 el.l� lili�� I C/.. /l e-:2'�c�.1'-� yl C� IA� 7�kb L�'�Y?f✓l .��C25S <br /> 1 � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): `�h���' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #�f List of Fixtures #°f List of Fixtures <br /> Fixiures Fixtures Fixtures Fi�ctures <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 3 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 /> s��ao����ma�su����ssso� sxs��� <br /> Number of Heads <br /> ACKNOWLEDGEMENT: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 /> current federal,stafe,and local!av✓. The granting of a permit aily authorizes app�oved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> E3uilding Offrcial before being aufhorized under any circumstance.I am the owner,or 1 am autliorized by the owner of this property to perform fhe work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI # <br /> ��� ��`�" - �./-�a , `�, �'�/� ._- <br /> Owner/Authorized Agent Signature Date (Revise 5/ 0/2016) <br />