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• <br /> I <br /> Alp a"-. <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> I'1 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ( lue or Black Ink :.my Please) PROJECT SITE INFORMATION <br /> �E <br /> PROJECT SITE ADDRESS: � /2 S t /fa- PROPERTY TAX#: C:Cii���6Z/010/ 2-i-L:- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • CONTACT INFORMATION • . • <br /> OWNER NAME: lergikkz, li..gtrIAtt-LivlOg._ TENANT NAME(If Commercial): r-L iR2 L-Yjl 10 t. <br /> OWNER MAILING ADDRESS: STREET 2:722//��,j�}�� W rIV C. Q �„ <br /> CIN rual tI STATE C•c.'•, ZIP f S20/ <br /> OWNER PHONE: OWNER EMAIL: <br /> I E U 2_. ._._._,_. <br /> CONTRACTOR NAME: <br /> I �(2-m00 STta-T0:: St•(ECT 1446TA-c- <br /> CONTRACTOR ADDRESS: STREET '2412-0 P�1 f ecu GI- <br /> s <br /> CITY S IW- fl STATE (A./4- ZIP i 2120 <br /> CONTRACTOR PHONE: 425.2c2.- /C CONTRACTOR EMAIL: M 0 C-594WA <br /> CONTRACTOR LICENSE#(REQUIRED): CO GSS 022.0 TCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (.16-7 di S - <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-J51-'2211c/ <br /> (vt� P it) CONTACT EMAIL: j c �55MwA . c <br /> BUILDING PERMIT APPLICATION . <br /> Existing Use of Building: Owl ce 1 Contract Price of Work:$ /0,goo <br /> Proposed Use of Building: A/0 e�46 Heat Source: gGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: I3(Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel I,RRepair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> RWLOVe 4., R rpoks W L exo etirtpIt flN-t- g-1.3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .MECHANICAL.PERMIT APPLICATION 1 PLUMBING PERMIT APPLICATION 1 <br /> Type of Project: _New_ Addn Alteration )`Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> nivO/� c�/►� City of Everett Official Use Only <br /> ( c-Si d I 1 la PERMI \�i/ �� �I1 <br /> Owner/Authorized Signature Date (Revised/2.0 2016) <br />