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��R�d9T Af��L9GAT10� <br /> �OJ9L.D9l�G I i�IE�F��NICA�.I ��U9V��IPdG /�9CN /���DY�I��..��I ��Y1�OL➢�°IOY� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@evereftwa.gov� www.everettwa.gov/permits <br /> ��lea��r�laek l�6s�n6y�lease) �R�J���'���'E 68����MA�'10� <br /> PROJECT SITE ADDRESS: ��) �fJ� �,�� �� � "6 PROPERTY T.4X#: <br /> LEGAL for new construction: Short Plaf/subdivision Lot No. (attach copy of long legai description} <br /> �O�ATAC`i' 19dPORMI�`TIO�I <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREe-r <br /> � C�7y ' STATE � ZIP <br /> OWNER PHOPIE: OWNER EMAIL: <br /> COIVTRACTOR NAME; �j��'��/J <br /> CONTRACTOR ADDRESS: s-rReer <br /> CIiY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIGENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY COiVTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BIIILDING PERMIT APPl.ICA'i'I�N <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-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �.� � �0� I�t/ �-o � . � � <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANIGAL PERMIT APPLIC�4T10N PLUMBING PERMIT�1PPLlCAYIONi <br /> Type of Project: _New Addn _Aiterafion Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #°f List of Fi�ctures #of Lisf of Fixtures <br /> Fixfures Fixtures Fixtures 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 j Other: ,�j f� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> S�RINKLElt/SUPPRES�IOM SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•/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,sfate,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.l am the owner,or!am authorized by the owner of fhis properfy to perform the work for which application is made, <br /> and I comply with the State Contractors Law 78.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> s���� ��'��� �/ ��/� P�R�iT#�� _ C1� <br /> � er/Authorize �g`ent Signature Date � (Revised 9/23/2016) <br /> �M1� OC� � d1S <br />