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Dec 18 2017 12:32PM Washington Wate tern 8663757454 page 1 <br /> OLTPERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING i SIGN/SPRINKLER I 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)everettepsijeverettwa.gov I www,everettwe.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ,,r, <br /> PROJECT SITE ADDRESS: a..57+3 � <br /> A j -rt. 5. PROPERTY TAX#: G l O ZL ZOO <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> epi �/ft CONTACT INFORMATION <br /> OWNER NAME: J�I �vt) ph; [j 1 y-- ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:: sneer 12 )3 al j�A''r'c c. 6 <br /> CITY I` J V �� STATE to,CA ZIP H2O <br /> OWNER PHONE: 421r OWNER EMAIL: <br /> CONTRACTOR NAME: um-9411u617-66i W,41`EtL. H6A7 -12J <br /> CONTRACTOR ADDRESS: smear I1 L if(, - 4-v c 5.6' p6 ,box 5926 g <br /> CIT -eft LiTVt1 STATE (IA- zrn 17,j �!/ O <br /> CONTRACTOR PHONE: 426--g '3- yg7/ CONTRACTOR EMAIL: W ,(JP-I jrf}C .. $j,i,9(L., cam <br /> CONTRACTOR LICENSE#(REQUI RED): G(IIt}- rt"CJg// CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). O5 gyeizi <br /> PRIMARY CONTACT: ❑OWNERONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT I �'jNAME• 1 CONTACT PHONE: C12�- ' '3-C/ '7/ <br /> �✓'1-`C� D 11"' !$ CONTACT EMAIL: G(� ' <br /> t}PithilG /L. . <br /> r� d, Bt1 ING PERMIT APPLICATION <br /> ([7 <br /> Existing Use of Building: . -.�y/�LG"�,j�/ Contract Price f Work:$ -0 53 <br /> Ili—.. <br /> Proposed Use of Building: Heat Source: ■Electric Dot •r <br /> Building Type: DSFR-Detached 1QAttached CI Duplex ©Mulli-Family-#of Units: ❑Com =rclal ❑in nal <br /> Type of Project: ONew ❑Addition ❑Remodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition MChange of se !00./I' <br /> ,44 <br /> DESCRIPTION OF WORK: ..� <br /> fie-IliA101/4_ k4I-' Rlif 1,0-r—k— ( 9/(it (11)aiitiftV-AledV <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Atkin _Alteration Repair Type of Project: New ,Addn Alteration __-Repair <br /> #of List of Flxturos #°f List of Fixtures #°f 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 /> i 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:1 have reviewed this application and confirm the Information contained herein is true end 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.`am the owner,or!am authorized by the owner of this property to perform the work for which application Is made, <br /> and I comply with the Slate Contractors Law 10.27 POW and 2002004 WAC. <br /> City of Everett Official Use Only <br /> ...>r., ,W / it 12 gP #���2 0(09 .... <br /> • , .. /.�• '•�iir,Agent Signet re Date (Revised 5/20f701$ <br />