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0 0 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.evorettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -ZI705 W. MtAr—( t-TEt> 51WD. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: polt, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CRY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME: LAI F-f HA I&H-'r$ l2OCT-ft, -- <br /> CONTRACTOR ADDRESS: l q- 14F, &1 'bo e7r <br /> P-MMOND WA ZIP lsoo <br /> CONTRACTOR PHONE: A-7 • S% • -MT CONTRACTOR EMAIL: ke-Or1t �aPv (/lG1f I�t•f• <br /> CONTRACTOR LICENSE#(REQUIRED):LA IZt<YHFI li CITY OF EVERETT BUSINESS LICENSE#(REQ ED):0$6 04 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) _ <br /> CONTACT NAME: CONTACT PHONE: L}79 •$$I -Crl 7 <br /> Ht31171 MAI ICONTACT EMAIL: keoc `o letv'r kat (A • ttw <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: FR-Detached FR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: 12+OF REFLAtE'SMt4T••• REMO/6 fcXK•r I146- RavFrIKCs MA1691A(.r <br /> t tac,TAL, . NC--W tlZ" FVf,, 04VE t.A"'tMrctsr" Gt" A%FRA L r SH I NG(,425 <br /> ASSOCIATED BUILDING PERMIT# if applicable): 9-�N J <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Prevent er(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 /> Chemical or Water I I No.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,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 /> Building 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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 6•S- 1-7 1 <br /> PE #1"-�(a +— O \ O <br /> oivner/Authorized Agent f <br /> ignature Date (Revised 9/23/2016) <br />