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� PERMIT APPLICATIO� <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� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r���L� ' p -� � Q.�/' �/ � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � <br /> 7� ��,� � � , f�y (,�v TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sraEEr (pL� QC',�r-�^� l�e� �6' C' <br /> CITY ��(�,ti'�Q� STATE u!� LIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: l�� �J ` ` 5 n % "'��/� � <br /> CONTRACTOR ADDRESS: sTREET j�� � � � L�� <br /> CITY C y� (�(,U�S` STATE �'//�� ZIP �pG�G. <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ( - '�'L� �Q (�j �S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> � � <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE: l�y_� _� � � —�C � � <br /> '� I CONTACT EMAIL: 2 e � D � �, <br /> �d'��/i '"{C �/7 `� � . 't U J �"� t "CC2 t � �C�c.� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: = Contract Price of Work:$ dL? "� <br /> Proposed Use of Building: Heat Source: ❑Gas �IElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: "` <br /> �'Q�te✓� •�--- t(�¢ �a c e C'� �-•�.������' c�rl '�►'t�r'Tf �vUSt;: ��.5�� <br /> �l-�w �r��f --f,; b� ����I 1 e�( r�n -(��� h�vf� u-��� �c����-���� c�F .��t zs� Z ��-�u�L� o� <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): LF�r a � � ILL< <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fi�rtures Lisf of Fi�rfures Fi�ctures Lisi of Fixtures Fixtures List of Fixfures Fixtures List of 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 /> SPitINF(LEF2/ SIJPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work dwie pursuant to this permit must comply with <br /> currenf federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be aufhorized in writrng from the <br /> Building Otficial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of tf�is property to perform the work for whicl�application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereit Official Use On/y <br /> —f��� PERMIT � J � <br /> � �� L f!, <br /> Owner/Authorized Age Signature Date (Revised 5/20/2016) � \ <br /> I�7 <br /> L/ <br />