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PERMIT APPLICATIn <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 I FAX 425-257-8857 1(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1O5 0014 ST St.J PROPERTY TAX#: 28 0 41/2.003 039 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)$ krt-wrtAED <br /> CONTACT INFORMATION <br /> OWNER NAME: 1.4•Totrl./LtcS A4i ,uc* TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Y./5-30 30111 Z,Z/lot" SX, fwA're 2/o <br /> CITY 2 o T-HE 4, STATE !.M ZIP 040z/ <br /> OWNER PHONE: lac_90c4_270o OWNER EMAIL: MKtt46SLEy a iv'ro,Lr2ESA,. t+2te4, GoM <br /> CONTRACTOR NAME: Ig1itrLey-GoLE Ak55 OGtAT'ESf LL.C. <br /> CONTRACTOR ADDRESS: STREET 7 0 W OMLES AV eNs ru i rE (3 <br /> CITY FOB itE-rr STATE twl4 ZIP /filo I <br /> CONTRACTOR PHONE: MLS - 609- 040o CONTRACTOR EMAIL: `}Z('AwiT 2. e_to i Q rLey, Go1,,E , Gos/► <br /> CONTRACTOR LICENSE#(REQUIRED): t<4 9-1r L-c L.415 l%G CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ogZ969 <br /> PRIMARY CONTACT: 0 OWNER r CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM : CONTACT PHONE: .... a4.--p •scam. -1Z.5.2-55-3 <br /> CONTACT EMAIL: (Z$,twzLZ� ,,,,, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N►f k Contract Price of Work:$ 1 74S, '1 10 <br /> Proposed Use of Building: MArltbF,ac:rwt,,tst: + orrice Heat Source: tilGas VIElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: /Commercial 0 Industrial <br /> Type of Project: IgINew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign CI Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Nev., ofFic„t'n ► Jfrress..JM,4f. 13km%.ec.14. WITH APPR I^A/r$u/ 9N,Lia W FoortPit <br /> pan, III$ V 2oD + ?t2D FwOR- O'rf SPS• Stir; wtu.. Au.o•topft se )(O4 Pit QUA%A tTAL S. <br /> slit P(o:,n 4 Pug& Warks #- ls'su4 on 4./g12016 undEr 1%,ntuf l603-050 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S'$Qpr It,-co I ANP PW(6o3-Mio <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 Only ?"--\----\\, <br /> l / o/.6 PERMIT 1 ( Ofr OW 1� Ak <br /> / <br /> Owner/Authorized gent Signature Date (Revised 5120/2015) <br />