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PERMIT APPLICATIOI
<br /> /114PBUILDII' I MECHANICAL/PLUMBING/SIGN I :"RINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 ] FAX 425-257-8857 1(E)everetteps@everettwa.gov] www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: ,f-7/7 fi/C D„ ,,,5, ,/ 4vtL PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,P7-,c,,,,4...,-",,,y4,., L[ c TENANT NAME(If Commercial): Cu,.. ",h f- „IJi)
<br /> OWNER MAILING ADDRESS: STREET Pa /4, /775--
<br /> CITY
<br /> f"7•j”CITY Ch1p,h STATE AyQ„ ZIP .f$VA,
<br /> OWNER PHONE: 4/2/..,s-nt , /e,0 f OWNER EMAIL: •
<br /> CONTRACTOR NAME: Da,v i S re/ c I t, - 211 c..
<br /> CONTRACTOR ADDRESS: STREET 4/(,n/ (": A,,a,u J i- ea,.‘A Rd let z uz3
<br /> CITY /17‘..)1 1 t<0 STATE 4.441- ZIP 9$Z 7S
<br /> CONTRACTOR PHONE: yls'•77 s- 9Yv 0 CONTRACTOR EMAIL: kS61,Ke//er-GOIa✓flr hia . h.
<br /> CONTRACTOR LICENSE#(REQUIRED): DR„VZSS'I/OS PN CITY OF EVERETT BUSINESS LICENSE#(REQUI D): 026267
<br /> • PRIMARY CONTACT: 0 OWNER Ia1CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACTINAME: � CONTACT PHONE: !/if- 7/c../*to at- Zoo„�/ - 9 6 a /
<br /> v
<br /> n e li >(C.iI tn,e.I e.,, CONTACT EMAIL: kjdi 6,..,/fei- 4,,,rdr4 Ai,..,,/le.-. c ori
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: CO ."0,/ Contract Price of Work:$ 5-0/000
<br /> Proposed Use of Building: ,r.,,,"4.- Heat Source: Inas ❑Electric @Other
<br /> Building Type: OSFR-Detached OSFR-Attached @Duplex @Multi-Family-#of Units: Etommercial @Industrial
<br /> Type of Project: @New @Addition gRemodei ORepair ErT.I. @Sign @Sprinkler ODemolition @Change of Use
<br /> DESCRIPTION OF WORK: '/ w !p
<br /> .04'14- c.c.s'c. l i),,Ev 'S, 4 wN
<br /> i e -,'tai$4,4 6 ,c o C.Lc.‘?0,4,) Fra.",.
<br /> 3— 'L 'to J-1 .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI. ,
<br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn r Alt- ion __Repair
<br /> #of List of Fixtures #of List of Fixtures #of Li-t of Fixtures # f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixt
<br /> NC-Air Handling Units Heat Pump Toilet Bac °ow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bat ub i r''al
<br /> Gas Piping Boiler ( L.'atory(Wash Bas', 9 ' king Fountain
<br /> Water Heater Refrigeration '4 ower \ loo Drain
<br /> Gas Fireplace Wood Stove I if. en Sin : Disposal dp Grease ap
<br /> Gas Range Ducting Dish a -r r Roof Drain
<br /> Clothes Dryer Hookups Other: Clots s Washer Medical Gas
<br /> Range Hood e.!ter Heater Other:
<br /> Exhaust Fan Sink(Serv. c.) Other:
<br /> SPRINKLER I SUPPRESSION SYSTEM.
<br /> Chemical or Water 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 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 /> t City of Everett(erOfficial Use Only
<br /> ,� e 17 PERS\V ` — V JO
<br /> Owner/Author Signature Date (Revised 9123/2016)
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