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477- • PERMIT APPLICATIO. <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: "z-3 CJC) HE' (LL„ (12lC J`' PROPERTY TAX#:Za)O 1O2W 'Jj&C� Z.On <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> -77 OWNER NAME: t ( }I(r kj pozr(t5 (SLC TENANT NAME(If Commercial): er 0( EA ) TM)Lr S T- <br /> OWNER MAILING ADDRESS: STREET '� E- 1(?Ijt231 6 H 1.3 K em , <br /> CITY - STATE �f61 /, ZIP _tgrc <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 0 0 Y - tAA)i 66 fv-pc'kc-t--tie <br /> CONTRACTOR ADDRESS: STREET go — _F(e-�j ST. 2-6 J �8 G.-c 7 /` <br /> CITY SI)O (ft 114(S F) STATE k,4 ZIP G[ jv <br /> CONTRACTOR PHONE: 'f.ZS ZeM Z-31-6, CONTRACTOR EMAIL: Jr`. ca rsiaZ((C4 0o r-tik(ttWI cG:CAel ie'i-c444, <br /> CONTRACTOR LICENSE#(REQUIRED): ,000, fZ7 71 9e0 P41 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 554 J� <br /> PRIMARY CONTACT: ❑OWNER Cg CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �! CONTACT PHONE: las-- t'9 - Z.3 7 i< <br /> TOe? <br /> ti C) S`'��� CONTACT EMAIL: sk. .. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: fYl4,)0( Contract Price of Work: $ '(;c <br /> Proposed Use of Building: rill- JV r Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel 0 Repair DTI. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r <br /> cP Ls 1 x (' t z�1E iL ®Fief) S (tom 57-7,q4-6 C &L. c Q. <br /> S PR(tv KL:E ) <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 #of 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 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 /> Number 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 local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> B .ing• 'cial before beis e 7uthorized under any circumstance. I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> .nd I compl with th ate ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# / �' (j) <br /> ,/' l'�S ''� Z®1.�, i )C ill <br /> Owner/• •riz•d Agent Signature Date (Revised 5/20/2016) <br />