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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 /> lue `�r Black�l,�r�-Only,�P1 ae se) , `�-��„, .RR�.lECT SI'��INFORM�TION , �..�,��: � �� � �����,.. <br /> PROJECT SITE ADDRESS:�22 � U�Ia �T V � { � �ZQ PROPERTY TAX#: D � ����OZ bOC� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �=-fi� � `� CONTACT IN:FORIVIATION �:,��..... � ` � "' <br /> � ._ ._ � _.., _ . . ��. _ �, .,. � . <br /> OWNER NAME: J L �(�')Q � �` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT q2 2, p� �'}J <br /> CITY y�/ e STATE ZIP ���J�' <br /> OWNER PHONE: 'T".Zrj•2 2� LQ OWNER EMAIL: <br /> CONTRACTOR NAME: GL w ��/��"e. 1(•(,yyjhll?q "F' ���1 <br /> CONTRACTORADDRESS: sTReeT '��,Q� "t'�'` e <br /> CIIY �..����0 W+ STATE ZIP �g2,U <br /> CONTRACTOR PHONE:�''Z5• �� '�J' � LO CONTRACTOR EMAIL: � , � rt,�dn; Q� <br /> CONTRACTOR LICENSE#(REQUIRED): '�..7 (1r„L �4. IQ.� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):����'y <br /> � _ . _ a _ �_ . „ _. . . _.. � _ _ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: + D�.� -�^"� CONTACT PHONE:L,�.�S, �.� (� <br /> L.-• ,Q �,.,( <br /> CONTACT EMAIL: ��'�p d(�1 �G-•�GV-- <br /> „ . . � � , ,_. ti ; �: . . _ „ <br /> ` = ' `; BUILDING�PER,MIT APPLICATION .��ti ;. �� �_ � '�� <br /> - �f� � <br /> isting�Use of Buildin : Contract Price of Work:$ r'J a�. '� <br /> oposed 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 ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �r ;��� ��� ��v L� <br /> YJ�GU.�I� p� �'��.�1�'�11� <br /> ASSOCIATED BUILDING PERMIT#(if a licable: <br /> MECHANICAL PERMIT APPLICATION: ' `` ; PWMBING�PERMIT APPLICATION ' <br /> Type of Project: New Addn Alteretion Repair Type of Project: _New _Addn _ Iteration Repair <br /> #of List of Fixfures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixfures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Firepiace 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: f1V <br /> �iC <br /> �.SPRINKLER�/;SUPP�tESS10N SYSTEM: <br /> Chemical or Water No. of Heads <br /> �KNOWLEDGEMENT: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 /> rrent federal,state,and/oca/law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> �ilding Official before being authorized under any circumstance.1 am the owner,or I am authorized 6y the owner of this property to pertorm the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WqC. <br /> City of Everett Official Use Only <br /> , � �.'� . � PERMIT ��� �h y� � <br /> tJU <br /> Own uthoriz �gnature Date (Revised 9/23/2016) <br />