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PERN117'A,PPL9CATIOIW <br /> �IJILDING � CF9ANICAL./ PLl99Vi�IIVG I SIGRJ I�N�CLER I DE9V10LIT'➢ON <br /> CITY OF EVERETT PERMIT SERVICEc <br /> 3200 CEDAR STREET,EVERETT,WA 98204 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> � _ PROJEG`1°S1TE INFARMA7'ION <br /> _ . <br /> �JECT SITE ADDRESS: uiT� <br /> S�O �V$ E� (,(J�/ �°ROPERTY TAX#: <br /> LEGAL for new construction: Short Plaf/subdivision Lot No. (attach copy of long legal description) <br /> CONT/�CT IN�ORMATION <br /> OWPIER NAME: TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> .. , . <br /> _. <br /> : _ . . . . ..... ... . . . . .... . . _. <br /> CONTRACTOR NAME; 1� I�E L � ►� d- H"�A9n�G <br /> CONTRACTOR ADDRESS: sTrzeET f �, Gv <br /> CITY L yr(I/v(�vQO D STATE ZIP � � <br /> COAITRACTORPHONE: � _�7,y l.�(�' COIdI'RACTOREMAIL: B �,N,1 ,Q,��n�r�.�� <br /> CONTRACT012 LICENSE#(REQUIRED): � /J�'(��-�- l.� CITY OF EVERETT BUSIiVESS LICENSE#(REQUIRED): G��7�"� <br /> . .._. ................ .�.. . <br /> ...,, .., _...... . .. ............ ..�..... ... .. . . . _ .... . .. ... .. . . ...._.. .,. .,... ... s . ..,..,.. ,.. .. :,._.. . ,... :. . ., . ...... ...... :.. <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTAGT NAME: CONTACT PHOIVE: t�'�5��?S� 6 <br /> ��/� ��C� CONTACT EMAIL: -��,�J [, ���,^j�/�j� ,�.�— <br /> BUILDING PERMIT APPLICATION <br /> —ing Use of Building: Contract Price of Work:$ �.�� <br /> � ��uosed Use of Buiiding: 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: �'�,/���.� � N,ew �i!�'jJ�"lZ60r✓L �X}tA-Gt-S i �=f I"v S� /�'►'V D � /�P•fi(� <br /> 172Y'�.. U,,p�,,v r'. <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn ,_Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of �,psf of Fixfures ��f List of Fixtures #°f List of Fixtures #°f Lisf of Fixtures <br /> Pixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units " Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bafhtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heafer Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa( Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood �y� ,Q�— Water Heater Other: <br /> 2 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> '�IOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permif must comply wifh <br /> U�t federal,state,and local law. The granting of a permif only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> ng Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply wifh the State Cont�actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> � � �� - 0 <br /> e u orized Agent Signatur Da e (Revised 9 /12/20 5) <br />