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OLT PERMIT APPLICATIOI <br /> BUILDINC : !9ECHANICAL / PLUMBING / SIGN / at'RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: HZ,Z ei c"k S 1- .5,n.) ? PROPERTY TAX#: Z-`d 0.41 Zoo 3D 5 ?p t <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 3Nnifan1iL (Anti..-ry 'I,1, TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 3 Z o (...,9 ti, IF'ofC1,-)tiA ; <br /> CITY II tfz� rT STATE Uli1,1 ZIP —1'sZ c <br /> OWNER PHONE: (4 Z 5) riQj z, SS 4 S OWNER EMAIL: <br /> CONTRACTOR NAME: bi L -S o L u t-1 c_i..i <br /> CONTRACTOR ADDRESS: STREET 2(o n \'t I," S---, v3 2 I <br /> qq CITY LI NN"v o01 STATE w.°r ZIP `l L 17 b <br /> CONTRACTOR PHONE: 4Z - -74.4 - � a0 CONTRACTOR EMAIL: I �J <br /> 5 dl�VtcJC'Alt,So\L,` , rJ�inw,/tQl--- <br /> CONTRACTOR LICENSE#(REQUIRED): "biZ S tL.S L 41 14 . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5209 f <br /> PRIMARY CONTACT: El OWNER Cl CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 --/...._&- -'--1 4,4 -(, 0 0 <br /> I \) 401 t,,,.. L 4:71>r,1-Vr__ CONTACT EMAIL: Imu,i S\,3s 0 I uA,r•-. akL n,.„,, r« <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: OFT-(c>L Contract Price of Work: $ Z I) 1(c( 6,e'e\ <br /> Proposed Use of Building: Ot'F te.6 Heat Source: 'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached EISFR-Attached ElDuplex ❑Multi-Family-#of Units: tiCommercial El Industrial _ <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (Z moJ-Gy w .k)br,tL` Awl, <br /> c 4Qu l P, '-' 7 t (?ooi— ) ,,,¢.„NS vc,./}t£a <br /> Co Rt- gooF'1a(s Wo(; ..K <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures 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 /> f`' 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 (7.,X Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I 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,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 authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> t PERMIT# <br /> 1 k(6 \,.._ <br /> • uuthoriz6d Agent ignature Date (Revised 9/23/2016) / p2.', <br />