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����o-r�,���.ac�,�rio� <br /> �0.99LDE�IC 1 M�CF��aYdICA�1 ���,J�fi�lil�CC /SOGIV /�P�sY�9aa�.E�/ ��N1!@OLB�'10� <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 /> (�Bue o��I�c1c 1u�9��n��P�6ea�e� P�����`i'�9�� I�F��Nd�`��0� <br /> PROJECT SITE ADDRESS: f �� �� � '� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description} <br /> �ON�AC"�' IRlIrORMA'�006�1 <br /> OWNER iVAME: TEPIANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTaEEr <br /> � C17Y ' .-�- STATE � ZIP <br /> OWNER PHOPIE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1�j�(�j �/J �� <br /> CONTRACTOR ADDRESS: s-rrteEr <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER{Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BIIILDING PERMIT APPLICA'�'ION <br /> Existing Use of Buiiding: Contract Price of Work:$ Q� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> G�-� � �1Q1 ��V �-�o �t . ��� • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLIC�4TION PLUMBING PERMIT APPLICATION <br /> Type of Projecf: _New_ Addn _Alteration _Repair Type of Project: _New Addn Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Fixfures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixfures <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 Floor 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�� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.) Other: <br /> S�1z1IdKLER/SUPPRESSIAld SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confrrm 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 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 1 comply with the Sfate Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereft O�cial Use Only <br /> PERMIT# <br /> � ��f?�� � _ <br /> re Date � Revised 9/23/2096) <br /> O er/Authorize ent Signatu (� ��� ��r � <br /> \ <br />