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<br /> 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
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<br /> PROJECT SITE ADDRESS: � � � � PROPERTY TAX#: �
<br /> 321 50th t W Everett WA 98203 00606300002400
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer
<br /> CITY STATE ZIp
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME; Even Flo Heating And Air Conditioning
<br /> CONTRACTOR ADDRESS: sTReer 2�06 196th St S W#1�5
<br /> �,TM Lynnwood STATE wA Z,P 98036
<br /> CONTRACTOR PHONE: 4'Z5-381-0400 CONTRACTOR EMAIL:angellC @V2CIfI0Il@atltlg.COt11
<br /> CONTRACTOR LICENSE#(REQUIRED): eVenffh96Hm7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):049656
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4ZrJ 553-7�'J36
<br /> �1171 LOVatt CONTACT EMAIL:
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<br /> Existin Use of Buildin : Contract Price of Work:$ `��nn jOo �
<br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other
<br /> Buildin T pe: rPJSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel .�Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> Replace gas furnace like for like
<br /> ASSOCIATED BUILDING PERMIT# if a licable:
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<br /> Type of ProJect: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of Lisf of Flxtures
<br /> Flxtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld )
<br /> Forced Air S stems Unit Heater Bathtub Urinal
<br /> Gas Pipin Boiler Lavato (Vllash Basin) Drinkin Fountain
<br /> Water Heater Refri eration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Ran e Ductin Dishwasher Roof Drains
<br /> Clothes D er Hookups Other: Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other:
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<br /> ` �,��M P � � P�� S�Id ���'�`����w _
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•1 have reviewed this applica6on and confirm the informaHon contained herein is true and correcf.Work done pursuant to this pertnit must comply with
<br /> current federal,stafe,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authonzed in wri8ng from the
<br /> Building cial before bein orize er any circumstance.I am the owner,or I am authorized by the owner of this property to periorm the work for which application is made,
<br /> and/co y with the Stat Contractors La 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use Only
<br /> PERMIT#
<br /> i� 7�20 l�, � ,,.. �
<br /> ner/ orized Age Si nature Date (Revised 9/23/2016)
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