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0-44"7" PERMIT APPLICATIONM' <br /> BUILDING / MECHANICAL I PLUMBING /SIGN I 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 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 /> 2 / ¢(/ f/ <br /> S t--tie.rr/`f 1PROPERTY TAX#:0(SS �lS",zdG!C3 2_<2O <br /> 192v <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A c /,,..s ( f(kj 0, 7'-2 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2//a /4/f S,.4. , <br /> CITY tlipee.fi STATE i V et ZIP 9g:20 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: s(--p S-" i (� <br /> c F"t"/ �JC S 4 <br /> CONTRACTOR ADDRESS: STREET '.30 /3(sf .e <br /> CITY Tge`(Ca_G4 ,f STATE LI ZIP .'F.'0�' <br /> CONTRACTOR PHONE: 20C .2S 7 7/3 3 CONTRACTOR EMAIL: (.:5-07.1C/Jo/ /4 Lie'-9,4�ter. "4,6-'4 l'og <br /> CONTRACTOR LICENSE#(REQUIRED): CC Sc,-s P` lot gl-P4ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED)6c5 77Q <br /> PRIMARY CONTACT: 0 OWNER tiCONTRACTOR 0 OTHER(Please Specify) <br /> CON T NAME: CONTACT PHONE: '2 O 2S7 /..??ee- - /` am c CONTACT EMAIL:Se is N7 rC U0, 'r�i�// <br /> t,,.,e s�0,9 l f lC a 4 <br /> p BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: sfK Contract Price of Work:$ CQ 41®<71- <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: I[.SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION// OF WORK: <br /> VQ (� 4rY _<e%Sm; C pe-i,,,(` �"/ <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 /> NC—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 /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:1 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 /> --/C--/ - <br /> PERMIT <br /> #ijfso(-'07a <br /> er/Authorized Agent Signature Date d; ed <br /> 23/2096) <br />