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IIIIIII �I�l��i9`� ��1�9�9C�►�QO <br /> f��D�1L��1� 1 ���6��f�l��N�/ P��.�li�����/Se�h� R➢I�l�l��f�/�[�6�8��.9�'��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> Q�6a�����9���5 6u�1���vB�P���se➢ P��J��`�'��'t�� 6�1��1�6�DL�'1���� <br /> PROJECT SITE ADQRESS: � J�� PROPERTY TAX#:�.37� 2 Q� <br /> LEGAL for new construction: Short Plabsubdivision Lot No. (aitach copy of long legal description) <br /> (���e9`���u' ��l��f�@Ut�`���� <br /> OWNER PIAiViE: �Q TENAIVT MAME(If Gommerciai): <br /> OWNER i111A1L11VG ADDRESS: sTReer 3 <br /> � CIN. �� STATE w � ZIP �� <br /> OWfVER PHONE: ..- OWNER EMAIL: <br /> CONTRACTOR IVAME; � <br /> C�NTRACTOR ADDRESS: sTReEr ��p � 13 <br /> ��7-y N� STATE �-' ZIP ��3 <br /> COfVTRACTOfZ PHONE: —77 CONTRACTOR EMAIL: �� [� �,fl/V ^j�, 2 <br /> �" CONTRACTOR LICEfVSE#(REQU(RED):�j /�J C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED):��q'7 <br /> PRiMARY CONTACT: ❑ OWNER �ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: COIVTACT PHONE: l�Z����.-�L! <br /> ��� ���C CONTACT EMAIL: $�� � � � � <br /> �U1LD1�#G P�Y2M9�'APPI�l��4`�'HO� <br /> isting Use of Building: Contract Price of Work:$ �c./ <br /> roposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached R-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑lndustrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �,��fl� ���� �-�,I ���,� �Z�, ���� � �QM,A-�C <br /> �Ti"r-� <br /> N 5Am-� 1.o c,�o►� N c� ��e�.c� C'rs�-s Pr����- . <br /> ASSOCIATED BUILDING PERMIT#(if ap`plicable): <br /> IUiE�9�lATI1CAl, PE12M1'S APPLiGATiOd�B Pl.i1M�11f�G PERMIT I�PP�,I�.�T10�9 <br /> Type of Projecf: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alferation _Repair <br /> #of List of Fixtores #�f List of Fixtures #of List of Fixfures #°f List of Fixtures <br /> Fixtures � Fixtures Fi�ctures Fixtures <br /> A/C—Air Handling Unifs 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 /> Clofhes Dryer Hookups Ofher: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Moptetc.) Other: <br /> �1�a29�@Ca,E�/SIOP���S�G�� SYS7'�N! <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correcf.Work done pursuant to this permit must comply with <br /> �rrenf federal,sfate,and locallaw.The granting of a permit only aufhorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from the <br /> —uilding Officia!before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property fo perform the work for which application is made, <br /> �d 1 comply with fhe Stafe Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereft Offrcial Use Only <br /> PERMIT# <br /> l z�f I � SQ!- �s <br /> Ow ufhor' d Agenf Signature Date (Revised 9/2312096) <br />