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� � <br /> PERMIT APPLICATION ' <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> GTY OF EVERETT PERMIT SERVICES �I <br /> 3200 CEDAR STREET,EVERFTT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wwnv.everettwa.gov/permits �� <br /> PROJECT SITE INfORMATION I <br /> PROJECT SITE ADRRESS:, PROPERTY TAX#: '� -� -,._ � <br /> ,� �. �_ , � , r � �-- �G �_� � ,� -U�, �-�� ,, o u <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) � <br /> CONTACT INFORMATION ; <br /> OWNER NAME: f"� (���S CC � TENANT NAME(If Commercial): � <br /> � <br /> OWNER MAILING ADDRESS: srReer /Z,�G�� � � 7� `� '�C i <br /> CITY ��� � STATE 7.IP ylP(/ , � <br /> OWNERPHONE: ��ZS �UZ �>G'Gj OWNEREMAIL: �t{irfS � �t� /y(� .�.G�/ ' <br /> /,� � <br /> CONTRACTOR NAME: C/U .� Ti(��/ �ij ' <br /> CONTRACTOR ADDRESS: sTrteer �G� Y�(; ' <br /> CITY /��l �,%f STATE LI ZIP `jpG Z I <br /> 7c� 27� 975 � <br /> CONTRACTOR PHONE: ' CONTRACTOR EMAIL: /��'S "v C� l <t,c��7.• �(�'/ <br /> /� J <br /> CONTRACTOR LICENSE#(REQUIRED): U U G� ✓�9Z UC Z— CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): � �!;�(' � <br /> PRIMARY CONTACT: ❑OWNER C�CONTRACTOR ❑OTHER(Please Specify) �V ! <br /> CONTACT NAME: /^ � i������� CONTACT PHONE: '?�� � '��j — 7�� �� 1�� ' <br /> � `��`�' / �'� y CONTACT EMAIL: > > <br /> % S C U d � � l�l� C�> � ��� <br /> BUILDING PERMIT APPLICATION ' � <br /> [ <br /> Existing Use of Building: �E'S�C�f'��c.-�- Contract Price of Work:$ //`� ���� ` �' k <br /> Proposed Use of Building: ��S/`C� C.�' Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial ` <br /> 4 <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ! <br /> S� � �`�`,����� � ��� ���y �����-f : <br /> � � - _ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �� U:����i`.,C,�� I� � � �,'�G�i !✓V � � `� � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION � <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration Repair i <br /> #�f List of Fixtures #of List of Fixtures #of Lisf of Fixtures #of List of Fixfures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 Kifchen Sink&Disposal Grease Trap <br /> Gas Range Ducfing / Dishwasher Roof Drains � <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> � <br /> Range Hood i Water Heater Other. �� <br /> Exhaust Fan Sink(Service/BarlMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYS7EM � <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> cu�rent federal,state,and locallaw.The granting of a permit onty authorizes approved work and no deviafions therefrom.Deviations must first be authorized in writing from the <br /> [3uilding Official before being authorized under any cir umstance.I am the owner,or I am aufhorized by The owner of this property to perform the work for which application is made, '� <br /> and I comply wifh the Sfate Contractors Law .27 CW and 296.200A WAC. I� <br /> ,�f Ciry of Evereft Official Use Only <br /> , ,, <br /> ' ' PERMIT# �� �/ � � ' <br /> � - � . _ � ¢ <br /> , - ;�� <br /> i' ' ���< 6 <br /> Ov�riier)Aut�o�zed Ager� Signature Date (Revised 10/12/2015) <br /> %. � <br /> ! <br />