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� PERMIT APPLICATION � <br /> BUILDING / MECHANICAL 1 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 /> (Biue or Black Ink Oniy please) PROJECT StTE INFORMATION <br /> PFtflJEGT SITE ADDRESS: 9OZS I I�' �,�,�, �rjJ �"'�/E��7l �?� PROPERTY TAX#: UV�T �SZ G�J,� � <br /> LEGAE...for new construction: Short Plaf/subdivision I_ot No. (attar.h copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��� +�j-' E� � TENANT NAME(tf Commercial): <br /> OWNER MAILING ADDRESS: srRe�r Q 2 j� ��'�7'` <br /> �=�ry �V�C�" �r,� ,�-' ,�. �p <br /> OWNER PHONE: OWNER EMAIL: "��"f? �7 , <br /> COMTRACTCIR NAME CD�i1J � <S7`Z�N�E e�G�F/N� J NG. <br /> CONTRACTORADDRESS: sraEEr I7G��I IS� ��,tQ 6'£ � QJ/g <br /> ��N �r�y�'�� -�:�s G�A- ��P 9���. <br /> CONTRACTOR PHONE: �S— �S— CONTRACTOR EMAIL: �jQ�1,��' ��QQ�'}flNCr.CGVr1 <br /> CONTRACTOR UCENSE#(�tEt�UiRED�: C.�1,��J1/��'�"p,1,:j,C/'y'J CtTY OF EVERETT BUSINESS LICENSE#(RE�UiRED}: D,3�'"(r <br /> PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑OTHER(Please Specify) � <br /> CONTACT NAME; CONTACT PHONE: YZ6.�18�—D/// <br /> �AQA GDiPN/6rT� �F�/C� �JANAC7F� CONTACT EMAIL:SA'�/4 CDRNE/P�7ZY✓�'QC�F�NC�.�',p/y/ <br /> DUtLdtNG PERMiT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ /� 9�T/ • DO <br /> Proposed Use of Buildin t.�f�{1� Heat Source: ❑Gas ❑Electric ❑Other <br /> 6uticiir�c� T �;�; L�'�FR-Detached ❑S�R-AttacMed ❑�upt�x ❑MulFi-Family-�`�of Uniis: ❑Commercial ❑Industrial <br /> 1`y�e of t�rrj�c,�i ❑New ❑Additian ❑Remodel F2��;��r ❑T.I. ❑Siqn ❑S�srii�kter ❑Demolition ❑Ch�ngc af Use <br /> DESCRIPTION OF WORK: �" <br /> l�'�-�- : ��rnou� Co�»2�oro�c,f�'�rx 4 r�c�� �v� C��-i�, <br /> A&SaCIATED BUILDING PERMIT#(if aEt slicab(e- <br /> MECHANICAL PERMtT APPLICATfON PLUMBING PERMIT APPLICATlON <br /> Type of Project: _New _ Addn _Alteration Repair Type of ProJect: _New _Addn ____Alteratfon Repair <br /> #of #of <br /> Fixtures Llsf af Fixtures Fixtures <is!of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixiutes <br /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinaf <br /> Gas Piping Boiler Lavafory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink 8 Disposal Grease Trap <br /> G�s Ran � Ducting Dishwasher Roof Drains <br /> Clothes[7ryer Hoc�ku�s Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(ServicelBarlMo letc.) Other: <br /> SPRINKLER/$UPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT. I have revieweA lhis applrcation and confirm the informa7ion contained herein is true and correct Work done pursuant to this perm�l m�st comply with <br /> r,urrent Iederal. state,and local!aw The yranting o(a permit only authorizes approved work and no deviations fherefrom.Deviations must firsl 6e autho�ized in wntinq from the <br /> Buifding Official before being aulhnrized under arry cucumstance 1 am the owner,or 1 am authorized by fhe owner of this property to perform the work tor whrch�pplkafion is made, <br /> and I comply with the Sfate Gontraclors Law 18 27 RCW and 296 200A WAC <br /> City ot�verett 08ir,iaf Use Qnfy <br /> , �Brn.�+� P�� � � ' V� <br /> Ow�ier A��thorized Agent Signature Date {Fdeursed 5i2Qi'�07C,f <br />