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Uv' PERMIT �4PPLICATIOP� <br /> Ifi-P,"//--_ ..-ABUiLDIN=NI ECHANICAL/PLUMBING I SIGNINKLER I DEMOLITION <br /> .I* CITY OF EVERETT PERMIT SERVICE= <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 /> :....: .a:..G.._ .._ _..< ... .,..: . ..., ... .t . . CT SI iNRQRIVI Tl4>hl�;��::��;. .'�a .;��<` :: .�.'.::,��: :-<;:,; <br /> FR1JE ADISL�' : : (PR0re 5 ?X�id Z tt QD' ®d 3 <br /> LEGAL for <br /> rnnew constr�ucltioon: Short'Pllaatt/s�ubdivision '4 !c•Z I Lot No. (attach copy of long legal description) <br /> i <br /> ...:;. ,ONTAt3'F;IN#0R1ViATi0N;' :1��•�-.:. :.;:, <br /> OWNER NAME: g&i, f,4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET re:". „70IC /Du /' <br /> CnY 6.40-10-#06.40-10-#0 0 STATE (t/A A. ZIP �jZ•�/� <br /> OWNER PHONE: ..•• 14'3• /Z- OWNER EMAiL: a w _ . <br /> CONTRACTOR NAME: 71 ,0' i.J OIL'1 c191 ' 41 01 0(Mk/ <br /> Le <br /> CONTRACTOR ADDRESS:, STREET <br /> CITY STATE ZIP <br /> CONTRA9TOR PHONE: CONTRACTOR EMAIL: <br /> ,. CQNTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):06.1glig <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR *OTHER(Please Specify) talte,4,WAX/11i411 ."f02, <br /> CONTACT NAME: CONTACT PHONE: ¢05 .3 '5.94es <br /> CONTACT EMAiL: 1K' ISltamyi,`✓/' 1, ... -- <br /> .:.:.:-4_:.._t:-... ...-,..A_._...>•...:_:.T._.. _. _:..z... . ::B.l1:[1Lb1N.tPgRFIll1rAPikICA;TXO15KK$ :.::-•. -_.-::_..+:. <br /> Existing Use of Building: Contract Price of Work:$ %ti Or MO <br /> Proposed Use of Building: fj ,i Zi ,Z3' Heat Source: 1:1Gas 4jlectric ❑Other <br /> Type:T e: ❑SFR-Detachei 0 R-Attached ©Duplex DMu1ti-Family4 of Units: 0Commercial likdustrial <br /> Type of Project: { New ClAdditi n [Remodel. iJRepair LIT.I. OSign OSprinkler [Demolition ©Change of Use <br /> DESCRIPTION 0;14/CK: • ll&e, 4 $Gp'4, &41-171O/." 6 7.! , a„,,,. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ; <br /> 1 <br /> °. •:`:,.1� M,:EGHAI0A :PRMIAPL'CtTf- :; _ - t LUMBI 7G.PEMT:.APFCICAiO <br /> - <br /> Type of Project: New_ Addn Alteration .-pair Type of Project: New Addn • - -tion ,Repair <br /> #of List of Fixtures # List of Fixtures <br /> Fixtures List of Fixtures, #of List of Fixtures #of xtures <br /> Fixture Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(VVas. Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain. <br /> Gas Fireplace . : Wood Stove . ' Kitchen nk&Disposal Grease Trap <br /> Gas Ran•' Ducting Dish es-her Roof Drains <br /> Cloth-- Dryer Hookups Other: C= es Washer Medical Gas <br /> R-,•e Hood ' ater Heater Other: <br /> haust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ::.:: _SP;RiNKLER(QUAPRE'S 100.: YS 0.130-_:::,' <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 1 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 Only <br /> PERMIT# <br /> C Iii, Ar001(610 e3l d6 '. ®l `f <br /> ••r/Aut orized Agent Signature Da - (Revised 10/12/2015) <br /> , <br /> f ,' <br />