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PERMIT APPLICATION 1 <br /> BUILDING I MECHANICAL/PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> . 0477 <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: <br /> .�1 /�► �C.4 PROPERTY TAX#: t o 3/Z0^"boo~( z"03 <br /> LEGAL for new construction: Short Plat/subdivision 225 A) -I2t Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: GI 1 e to K 110 try?11\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 1 z &1y' f)✓t"SS 1411 C <br /> CITY S a/AO tS(( STATE W A, zip 78 aq 6 <br /> OWNER PHONE: L!ZS^^3 L/q^ (-1 6 3-2- OWNER EMAIL: d GF/?'O')aPt @ 4.400 -CAs-t <br /> CONTRACTOR NAME: C fey" Ho✓`a9c ii <br /> CONTRACTOR ADDRESS: STREET '. 112/ �-y,r'eSS `a P C <br /> CITY . //1 0/i o fl/S/11 STATE /..t.)A ZIP 98/ 2,Q0 <br /> CONTRACTOR PHONE: W 2 C- 3 = _— ,R EMAIL: "ld e,ea-/Ice- a's- 0 4Gt•.. -.._� <br /> CONTRACTOR LICENSE#(REQU - • OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: CH'OWNE- .. -., - - i • • R(Please Specify) <br /> CONTACT NAME: tie> <br /> PHONE: i'��S 3 q t7/_q{B 7 Z <br /> (:? ,�leo n !t V94111. CONTACT EMAIL: 50 G F"--7„,,,,,, € xe 4,0 .Cts <br /> /BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: .5i�y/e 10 ill, 4 .L <br /> Contract Price of Work:$ 4 9 ,- 0 0 <br /> Proposed Use of Building: �i.a f4 -4I//ly Heat Source: ❑Gas Electric .❑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 ❑Chhange of Use . <br /> /! <br /> DESCRIPTION OF WORK: f / 6,,,,y4 /y4 _74,n, /y, 7/4 c15, T, E.x lS 1":77. f'7/t ��.SC' ro <br /> /`1?ke 4 D ct,/eX • <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 #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 7 Toilet Backflow Preventer(Inside Bldg) <br /> /. Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping , Boiler SLavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> / Range Hood ,fi Water Heater Other: <br /> 3 Exhaust Fan Sink(Service/BarlMopletc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ! 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 /> and l comply with State Contractors Law 18.27 RC nd 296.200A WAC. <br /> City of Everett Official Use Only <br /> -3 _/3—/ PE''*,jj r��v <br /> wner Authorized Agent Signatur Date (Revised 9/23/2016) j. <br /> i <br />