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• PERMIT APPLICATION• <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /�PRINKLER/ 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 lnk Onl Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� ra .Q, ��� PROPERTY TAX#:U(�5�,(p2,-UIO "�� �Ol <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: h �f � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sraeEr Z�]� <br /> ��� l� ee� STATE � Z�P $Z- <br /> OWNER PHONE: � OWNER EMAIL: h �,�/ - .�.�' <br /> CONTRACTOR NAME: Cj � -�'u, � ��S <br /> CONTRACTOR ADDRESS: sTaeer �p <br /> GITV �11 -e��, STATE ZIP B�, <br /> CONTRACTOR PHONE: '� �-� CONTRACTOR EMAIL: h � �f� -�OI/Y1eS• <br /> CONTRACTOR LICENSE#(REQUIRED): � � r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � � .- <br /> ��h �,��� CONTACT EMAIL: 51 ,� <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:$ <br /> Proposed Use of Building: S� Heat Source: Gas ❑Electric ❑Other <br /> Buildin T e: SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF ORK: l+„��.�..,/���, L. � ��w ��,�7 <br /> l.0 `�� r a v��n i� <br /> ASSOCIATED BUILDING PERMIT# if a licable : <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 #�� List of Fixtures #of List of Fixtures #of List of Fixtures <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 3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration 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: t 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 informa(ion contained herein is true and co�rect. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviarions must first be authorized in writing from the <br /> Building Officia/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/com w�h the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /. <br /> City of Everett Official Use Only <br /> PERMIT�#� <br /> ,!� � � i 2� / �. ,� `l r� � -.�J ,�'� <br /> O er/Authorized Agent Signature ate (Revised 9/23/20i6) � <br /> � � <br />