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� PERMIT APPLIC�4TIOfV�
<br /> �UILDING / MECHANICAL/ P�UMBING / SIGN / SPRIiVKLIER ! 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 Anly Please) PRAJECT SITE INFORMATIOPI
<br /> PROJECT SITE ADDRESS: % � �/ /%• , 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: ;• -j-� � ��,�%)�,,% TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTrzeer --� �r ��
<br /> CIT1' D1'1lYV IL�� STAT� �� ZIP 9 � ! '�
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<br /> OWNER PHONE: ` -�� r� _ �' OWNER EMAIL: ,;�'�`<-r ; r , i i.:: � - `! f; � , � -'�j'.'�
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<br /> CONTRACTOR NAME: 1<,OG-K C„ �� r �,1 , .j`�-I�' ' �" � J'�, ' � _ ,,
<br /> CONTRACTOR ADDRESS: sTREET / ,--=� !--�;� �.((�' � (/�/�.� ��
<br /> CITY C U f" 1" .� , STATE ZIP C �'^� `�
<br /> CONTRACTOR PHONE: ZO�Cj - i� ,' ?- Z'' ~1 � i�`,� i _�';� ,a-_- .1.,�.� ,,y-,`� 1 � -
<br /> � CONTRACTOR EMAIL:+� � �
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<br /> CONTRACTOR LICENSE#(REQUIRED): f{ ti'y t ,'''}� � �, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED : p��J`"� 'c;�.
<br /> PRIMARY CONTACT: ❑ OWNER �0_CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ' '• '
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<br /> ''�� ' �" I� C �; i�i �� CONTACT EMAIL i"� ' � .:.,. . ,e,f- . , i
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<br /> BUILDING PERMIT APPLICATION
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<br /> Existing Use of Building: Contract Price of Work:$ --��T— � ��) � � •
<br /> Proposed Use of Building: Heat Source: �Gas ❑Electric DOther
<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: ,- � ,� � . . •i ,.: ' f ; , ; � �� r< ,. _.
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<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 #�f List of Fixtures �°f List of Fixtures #of Lisf of Fixtures
<br /> Fintures Fixtures Fixtures Fixfures
<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 /> Chemical or Water 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 loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must frrst be authorized in writing from the
<br /> Building Official before being aufirorized under any circumstance.l am the owner, or l am authorized by the owner of this property to perform the work for which application is made,
<br /> and I compty with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> ' City of Everett Officia!Use Only
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<br /> PERMIT# • -
<br /> ` - /'';t f� . � . 4 -� � � �_ . � ' �J V V V 'V V
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<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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