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• PERMIT APPLICATION <br /> • <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 !nk Only Please) PROJECT SITE INFURMATION � �� <br /> PROJECT SITE ADDRESS: ? t <br /> �,L-� � c>� .L- �� eu� �1 v c_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> GONTACT INFORMATION <br /> OWNER NAME: ��,•,4 t ' c- ,-- , \ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr Cj�� � k� {�._ 11 c„ �'J v c, <br /> CITY �J;�re.� STATE l.V 1� ZIP `���(J � <br /> ,� <br /> OWNER PHONE:�U�: -�{S - j D�Z OWNER EMAIL: <br /> CONTRACTOR NAME: /�{-F�>,�,1�t�,(� f�<<,�,,�� ,i C_v c ( � v�c 1 n c. <br /> CONTRACTOR ADDRESS: srReeT �j s �'�� ,(� , S �. <br /> r . <br /> CITY �Gt T G S��c Y'e��13 STATE �{��� �� ZIP ��5.`S� <br /> � � <br /> CONTRACTOR PHONE: �Z - 3 3`-1-��I D C� CONTRACTOR EMAIL:�l��;k���, �,,�4 �_ r„ �.�� ..,. ���t'. ,•«.c�.•,�� <br /> CONTRACTOR LICENSE#(REQUIRED):/'{F/-C,��{Ty 1�K�: CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) � �5 2Z j <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE:yZ}-3 j y-S'�j��, '<__�..-� <br /> �-(-,c.�' I �=s G'c ,-.:Ae.� CONTACTEMAIL: <br /> c6iw k�_�, <<,�ic(.�._'���vcc�e::,{,_ . 1• - .cc, - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �r� �<(r��c` Contract Price of Work: $� �5 E L �y� <br /> Pro osed Use of Buildin ' � <br /> P 9� ��5�r�tti�N Heat Source: �Gas Electric ' ❑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: �l1 / ! <br /> (1'1 � '�s�l.i-t 1 � fi.� 1�G���t��� _l 'lL C7LI.S�I�tv.�-i f+`�S -T �.:,1��-�L � cten�\ ✓L`:���_. . S�.%h` t�i;cf-L�/. .`� <br /> � � J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MHCHANICAL 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 #of List of Fixfures <br /> Fixtures Fixtures Fixtures 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 writing from the <br /> Building Official before being authorized under any circumstance. 1 am the owner,or I am authorized by the owner of this property to perform the 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 /> C-/;��ti �_ �J�,,,��x � I -2 ��-2_���� P��# `�-O� - D� � <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br />