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PERMIT APPLICATION <br /> BUILDING/MECHANICAL i PLUMBING/SIGN/SPRINKLER 1 DEMOLITlON <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/permfts <br /> Blu+�or BY�ck lntk Qnt 'Please PR�JECT$ITE,fiNFOitMA7'10N : , <br /> PROJECT SITE ADDRESS: � PROPERTY T <br /> LEGAL for new canstruction: Short Platlsubclivision Lot No. {attach copy of Iong legal description} <br /> '.CONTACT INFORMATION <br /> OWNER NAME: �A'�� ��A�1"j� ("�-Ci' TENANT NAME(If Commercial): <br /> OWNER MAILWG ADDRESS: sTaeer J .� C� �jI��Z � W <br /> ��n �v�.2��ta � STATE �P Z�� <br /> OWNER PHONE: � - - f( f� OWNER EMAIL: �0� Q.�] y'O�.yl G�C.D110 �G ✓'0 ` . yy� <br /> CONTRACTOR NAMI � <br /> CONTRACTOR ADDRfSS: srn�r <br /> CITY STATE ZiP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 2t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 2 <br /> PRlMARY Cf3NTACT: ❑OWNER ❑CONTRACTOR I�THER(Please Speeify) � � C�iT <br /> CONTACT NARtfE: ��Z t �� CONTACT PHONE: �` �--�,Oj,1 <br /> � ��� CONTACT EMAIL: � � ` s" , (°,Q� <br /> _ _ _ <br /> BUILDING PERMIT APPLtCATfON ` <br /> Existing Use of Buiidin : j Contract Price of Wwk:S e�� <br /> Pro osed Use of Buildin : � i Heat Source: ❑Gas Electric ❑Other <br /> Buildin Ty e: ❑SFR-Detached OSFR-Attached ❑Du lex ❑Multi-Famil -#of Units: Commercial ❑Industrial <br /> T of Pro'ect: ❑New �Addition ❑Remodel ❑Re air T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIP710N OF WORK: <br /> ��,-�'�o�- o�-LY� N o�l -5�Iw��"�12/�-�- 1�•TA-��. �T; l. �-7'a ,�.xl S7"I/�G fZ�iA-iL- <br /> �'�-5�'�Pf1-c.� �o� `�`'Sl�/�1�.���� S 7'0�, C Z37(�, ,�� � <br /> ASSOGIAT D UILDING PERMIT# if a licable: <br /> MEGH/kN1�AL PEMtMiT APRI,ICATION' ! PLUMBINGi PERMfT ARPLICIlT1�N : <br /> Type of Project: _New„_ Addn � Aiteradon _Repalr Type of Project: _New _Addn Iteration _Repalr <br /> #of y�st of tiarfures #ot Ust of Fixtures #of Lisf of Fixdrres #of of Ftxtures <br /> Hxtures Hxtures Flxtares FixWres <br /> A1C–Air Handlin Units Heat Pum Toilet ackflow Preventer Inside Bid <br /> Forced Air Systems Unit H r Bathtub . Urinai <br /> Gas Pi in B ' r Lavato Wash Basi Drinkin Fountain <br /> Water Heater Refri eration Shower Fioor Drain <br /> Gas Firepiace Wood Stove Kitchen Si Dis osai Grease Tra <br /> Gas Ran e Ductin Dishw er Roof Drains <br /> Clothes Dryer Ho Other: es Washer Medical Gas <br /> Ran e Hood ater Heater Other: <br /> Euhaust F Sink Service/Bar/Mo etc. Other: <br /> SP NKL�R/SUPPRESSIQN SYSTEM <br /> Chemical or Water No.of Heads <br /> AC 'OWLEDGEMENT.�I have reviewed this application aod conflrtn the information contalned herein is hue and correct Work done pursuant to this pe�mit must compty with <br /> cunent federal,�ate,arrd local law.The granting of a permit on/y authorizes approved work and no deviabons therefiom.Deviafions must first be authorized in writing fiom the <br /> Building Offiaa/before being auttrodzed under any clrcumstance.1 am the owner,or/am arrthorized by the owner of this property to perfomt the work for which appiication is made, <br /> and/comply with the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett Offida/Use On/y <br /> �Z�-- PE�\�� — �` <br /> OwneNAufhorized Agent gnature Date (Revised 9/23/2016) <br /> /� <br />