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gri- PERMIT APPLICATI• <br /> BUILDI!, / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> LpROJECT SITE ADDRESS: /UJ 5flCi4/ilcq✓G ,L C PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .,%�7,vi / gym'/�) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4'�//0—�J?� y�s�yC/r 7frIC) j4 <br /> 1/4 <br /> CCIIITTY /e 1/G/GG // STATE tr��,4 ZIP 9z )3 <br /> INNER PHONE: /fo25 —c9/O — £/9J OWNER EMAIL: <br /> T <br /> CONTRACTOR NAME: /��':Xi Z---,--5/--,4k �•9i7Sh.�� / <br /> .,r•z'/4- drt s z.../.._c_/CONTRACTOR ADDRESS: STREET �- 1. 7// �/7C�f I1'S d 1 0 7� n <br /> CITY /y t, 5 ('2'11 J STATE L,//7- ZIP /a G 5f <br /> CONTRACTOR PHONE: v20 .- -775 —S--2._// CONTRACTOR EMAIL:cj7Z1�E72/9 Mo4".) 52 L 6' ', C_Cr7 <br /> CONTRACTOR LICENSE#(REQUIRED): L647— 5 3•VZ) CITY OF EVERETT BUSINESS LICENSE#(REQUIR=BY ( (r)) <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) k4 <br /> CONTACT NAME: CONTACT PHONE: gD4,- 7)(5.---5-2_/. I / / `l <br /> 57 z/ / 1U14z.t <br /> ,) CONTACT EMAIL: vs dc- lis i/J5 6-e C //�4 j L ,Ccvn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ i7i J <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel 0 Repair DTI. DSign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 6i— I <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 #°f List of Fixtures #°f 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 /> Building Official before being authorized 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 /> and I comply wit the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / 11Pli <br /> PERMIT# <br /> /� d4.,,,,,...- s--• /e-7// , &I(o(A ". Obs <br /> Owner/Autr orize'Agent Signature Date (Revised 5/20/2016) 7 <br />