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PERMIT APPLICATION
<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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> (Blue';or Black Ink;Oniy,_Please) , PROJECT,SITE.INFORNIATION, :;
<br /> PROJECT SITE ADDRESS: , Q s- � �/!S�C��� d � a�i.�� �t PROPERTY TAX#:
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> . .,, �, ,.. . � �,
<br /> ' CON'TACT INFORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReEr
<br /> C�7y STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> �.__,._..__._ .,,...._,. .._..�,....._ ,..�.._:, ....__. .....�..,,,... ...._... . ...�....___ .M,..-�--._._.. ,..�. ... ..� ..�,__. ...... .......... ._. ...,.,_.,...._,.,,_.._. .._ .. .,...�_ _.�..,.. .,...
<br /> CONTRACTOR NAME: �Cf � ���(-s�L`� �r- ✓—v S ��Ul� N£S
<br /> CONTRACTOR ADDRESS: sTRee-r �-� `�—� �-'�S C+� CZd • ¢r( �r
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: 3�G•-��1—� o� �b CONTRACTOR EMAIL: �CF�( ((d. �1lsvD tJ�f�(�,CW€•CQ�n.'
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER f,�(CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 3 6a,.- � ';`— �� `�- `�
<br /> .�L�� �Z L`1 �C.(2A1"..fl(�f� �2 CONTACT EMAIL:
<br /> ` , BUILDING;PERMIT APPLICATION '
<br /> Existing Use of Building: Contract Price of Work:$ �
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 1_ �� ��
<br /> ��,�o v�r� ��t S`�C �� �p ��l Gt� Cv'<G` I� F ��t,- c r� S� �- �` d— k�'t�
<br /> ASSOCIATED BUILDING PERMIT#(if a plicable):
<br /> _.
<br /> MECHANICAL PERMIT APPLICATION; ' PLUMBING PERMIT APPLICATION .. : '
<br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of (rst of Fixtures #of Ust of Fixfures #of List of Fixtures #of /��of Fixtures
<br /> Fixtures Fixtures Fixfures 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 Fioor 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 /> F�chaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> „ _ ,, . :.,
<br /> SPRINKLER/SUPPRESSION SIfSTE1V1
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the informafion contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,sfate,and loca!law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must firsf be authorized in writing from the
<br /> Building Official before being aufhorized under any circumstance.I am the owner,or I am authorized by the owner of this property fo perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�ciai Use Only
<br /> PERMIT#
<br /> .�- f(�r c- o ��
<br /> Owner/Author ed Agent Signature Date (Revised 5/20/2096) �
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