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47-7- • PERMIT APPLICATION • <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 ' t \ (; �.._ .;J,._.' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t,t.. -±k S`--:- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET W 3t'1 Y\k_o_Q_ R.QQ.. <br /> /y+ � <br /> CITY.• (i�V STATE � ZIPqR a <br /> OWNER PHONE: �4/2-c - S -J^ • 0 I Z I OWNER EMAIL: <br /> CONTRACTOR NAME: ,1 kIL \1 t A. {}'`j� �-�(N f.� Jtj I K-71 GV) S <br /> CONTRACTOR ADDRESS: STREET PD 1�C J <br /> CITY Ki(W S�r�l.L STATE 1A1 A._ � 4 ZIP v c <br /> CONTRACTOR PHONE: _r1 ..,> _ ` CONTRACTOR EMAIL: L.r1 6 :. .Q.,�' 1�1.�.�t 1 (�l , 1 <br /> (�(�� (�� �r i rrte�, ; r � t"i � � J <br /> CONTRACTOR LICENSE#(REQUIRED): I T 1C""' '1`---L (�c l--v CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(�S (t�S <br /> PRIMARY CONTACT: 0 OWNER 1Zi CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2) ;.C; . /...p .,f, -9 <br /> . ).},.. .i, r ik it-Y1 CONTACT EMAIL: 4?., C` f <br /> % v„,„66,,. ., , , <br /> BUILDING PERMIT APPLICATION <br /> �L U <br /> Existing Use of Building: Contract Price of Work: $ %/�0. 02' <br /> Proposed Use of Building: Heat Source: ElGas DElectric ❑Other <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 124I-�-c-1- 42- (, a--0 ILt--4J"' <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 /> i 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 I SUPPRESSION SYSTEM <br /> Chemical or Water I No. 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 /> .:nd omp 'ith the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> n City of Everett Official Use Only <br /> g — <br /> J __— LI-1 <br /> _ `� PERMIT, n1 / 0 <br /> 1.r01,2_,D`� <br /> Owne .1] orized Agent Signature Date (Revised 9/23/2016) <br /> ti <br />