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PERMIT APPLICATION <br /> 14ETT BUILDING ECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICL.3 <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: few &cues:44 d, ( JJe 6(;PROPERTY TAX#: .2f V`f I I D 0 2.00S 0 <br /> LEGAL for new construction: Short Plat/subdivision W �j•P_+,{ 4f .Q Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' r <br /> OWNER NAME: 'CL(�Lt &q p TENANT NAME(If Commercial): _ 14t2- <br /> OWNER MAILING ADDRESS: STREET P 64z. ( OqO �'/ <br /> crry E�jK W STATE A ZIP 7 5;.pg' <br /> OWNER PHONE: `(Z3 ' L(ceG S3fdOWNER EMAIL: 1 � P ac.4tf-'� Ftc tkc .coa�c <br /> CONTRACTOR NAME mak qtetAial,e sct( v� (Ma. U7. (J, <br /> CONTRACTOR ADDRESS: STREET .` 27.-7 •ts f a,j. _ - �Q be R'170 <br /> ow ea ilk- STATE WA zip 7 no q <br /> CONTRACTOR PHONE: ?-• (111 n 41.2 . 77\,0 CONTRACTOR EMAIL: fl4.Q, 405e-flea ,[©{f/( <br /> CONTRACTOR LICENSE#(REQUIRED):k?4 LEC X LA'I, (, CITY OF EVERETT `q BUSINESSNLICENSE#(REQUIRED): 0O' t i\ <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑OTHER(Please Specify) 11 <br /> CONTACT NAME: CONTACT PHONE: ZUt, r 42 7770 <br /> CONTACT EMAIL: ►r etqg Sr llGst.COWL • <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 5(=c(,'ZFC <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑/'( <br /> Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: j/ / J -a (`(ttlitC Ju <br /> ,v\p(rd,, n fi i-ttZ <br /> • <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 /> 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 /> City of Everett Official Use Onlyly �f <br /> CSL PERMIT# / 0� � Ili <br /> � 2 J 2?(b R <br /> Owner/Authorized Agent Sigriatur� Date r (Revised 5/20/2016) <br />