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� PERMIT APPLICATION � <br /> BUILDING / ECHANICAL/ PLUMBING /SIGN /S INKLER/ 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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS ^,��.; ?�i: �.`�:;, �r�. -:;=;-� _-1-�� PROPERTY TAX i�•�.'r�' �-��t.� �'%t.,�' � : ' e E.€ <br /> LEGAL for new construction: Short PlaUsubdivision �-�=`��• �=t t; :' �� : Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � �� ��.`.�: � t;a �-C°�t�.�,� =.,�•��a`� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReeT .�`'[;,�„� �, � �« ."--L �. <br /> a _ <br /> cm g;�\.t�t;�S`�; ,�k� STATE �;�.i\ r ;�' ?�. <br /> 0� ZIP ` <br /> OWNER PHONE: g ?•`'` i�,'•-=``��-`V OWNER EMAIL: y ".�' �; �J� - y <br /> �-!� �✓'e l.Y d-� � `< s•c.,�'_���r•-`' � �--" <br /> CONTRACTOR NAME: -�i,;:t E �-���LEy:�` <br /> CONTRACTORADDRESS: srreeer j���� � �'��� � t.' `�_ �� � <br /> "`� ri.� <br /> CITY .�'M `�l�t y�\..� i �.G.�� STATE ��E� ZIP '�': t � �C;��� <br /> y [`� <br /> CONTRACTORPHONE: '�?.` -�"-B��-Z`� � z� CONTRACTOREMAIL: ���;ti��(u'�'��'w�1 ��Iti F�� �- s �<<<'� �, CC� =�---- <br /> CONTRACTOR LICENSE#(REQUIRED):�Y,������5'�,�� y� k��; � CIN OF EVERETT BUSINESS LICENSE#{REQUIR D: � <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR �OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: � �e�__��� �; _.�E�� <br /> \ii�'�;.= �4 ` �`��!\��.��'�._ CONTACT EMAIL: i�,� � �'� l t-l.E��'4�'. ',!�.. ��"4•i`�-�t�.. L� - �; <br /> � <br /> BUILDING PERMIT APPLIGATION `� '� <br /> Existing Use of Building: S��- Contract Price of Work:$ '� �:�- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑EI ctric ❑Ot r <br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Famil -#of Units: ❑C mercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OT.I_ ❑Sign ❑Sprinkler �Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> p�:v�C� �� � 5�r-�-- � p � ��+c �+�� s f-�c� <br /> ASSOCIATED BUILDING PERMIT# if a plicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> Fixtures List of Fixtures Fixtures tist of Fixtures #of List of Fixtures #of List of Fiutures <br /> 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 8�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/Mopletc.) Other: <br /> SPRINKIER!SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this app/ication and confi�m the information contained herein is true and correct Work done pursuant to this permrt must comply with <br /> current federal,state,and local law. The granfing of a permit only authorizes approved work and no deviations therefrom.Devrations must first be authorized rn wrding from the <br /> 8uilding Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of thrs property to pertorm the work for which application is made, <br /> and 1 comply with the State Contractor's Law 18.27 RCW and 296.200A WAC. <br /> � � -R City of Everett O�cra!Use Only <br /> Y'� �.�� `�. ` J r � j, PE T# � - <br /> � � > � <br /> � �`� ` `� ( '��� t <br /> � i <br /> OwnerlA'uthorized Agent Signa ure ,� - Date (Revised 9/23/20?6) <br />