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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
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<br /> PROJECT SITE ADDRESS: � � Y✓ PROPERTY TAX#: f �jQ
<br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: ��.,� y�� � TENANT�NAME(If Commer ial):
<br /> OWNER MAILING ADDRESS: srReeT �
<br /> CITY ,�,j��'�� STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS: srReer
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) ��(�.I�G�c
<br /> CONTACT NAME: CAG�.� CONTACT PHONE:��� � - 2,1 S �
<br /> CONTACT EMAIL:�� rC' !'�eG -e�
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<br /> Existing Use of Buildin : � � Contract Price of Work: i�,
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric Other
<br /> Building T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT# if a licable:!1b'1 �• �Xt. /NG OFF1 CC 5 Q�w.c,"i.�. � ;,�.�.� cxNtb�ts Ge.
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<br /> Type of Project: _New _ Addn Alteration Repair Type of Project: New _Addn Alteration _Repair
<br /> #of List of Fixtures #�f List of ' ures #°{ List of Fixtures #°f List �xtures
<br /> Fixtures Fixtures Fi�ctures Fixtures
<br /> A/C—Air Handling Units Pump Toilet Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub rinal
<br /> Gas Piping Boiler Lavatory( Drinking Fountain
<br /> Water er Refrigeration Shower Floor Drain
<br /> Gas Fire Wood Stove Kitchen Sink&D' al Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes D Hookups Other: Clothes sher Medical Gas
<br /> Range od Wa eater Other:
<br /> Exh t Fan nk(Service/Bar/Mop/etc.) Other:
<br /> ;��4��,� SP�i� ER%��U�+�I����S�ION��Y� � '"`�� `��:
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<br /> Chemical or Water 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 pertorm 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 Otficial Use Only
<br /> PERM
<br /> � �� � < < -6� l�
<br /> Owner/Authorized Agent Signature . Dat (Revised 9/23/2016) � ���
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