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� PERMII'APPLICATIOI� <br /> �UILDING / hIIECHANICAL/ PLUM�ING /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 /> (Biue or�lack Ink Only Please) PRO�iEICT S17'E 1NFOItIVIA7'IORJ <br /> PROJECT SITE ADDRESS:7`b� �/' �' �^�r� I,�i� PROPERTY TAX#:i2$OSO'70030 b?00 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �t„ G �y�..�g,rS �u� �a, �j TENANT NAME(If Commercial): vq„(,,��'" <br /> OWNERMAILINGADDRESS: sTReer ��3$' StIJ y1(\�a�„7S- 5���'G Z�S <br /> � � CIT1' �,.,Q�,�.�(' , b�W Q � � 5TATE �� ZIP� ���3� <br /> OWNER PHONE: S�3 �O173 � �^'�-I Z?j OWNER EMAIL: I�!`e,�' l�.�a.L�r► �,y,�, G�,.{ti� , (,� <br /> CONTRACTOR NAME; �-rG.o� T r�,�I-' yv�, raJ�y�.Gv��" <br /> CONTRACTOR ADDRESS: s-rrteer ��p C� t Z„�!� E v'�-C � <br /> CITY BG�I Q,�V�� STATE ��' ZIP g O`�� <br /> CONTRACTOR PHONE: �7f"- � � �p$ CONTRACTOR EMAIL:' w��Sovl. GLf"C-D✓1- 1 . �-O r't <br /> CONTRACTOR LICENSE#(REQUIRED):CG �RLQN'("T'�(p�}G�S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O$'�o S'(orj <br /> PRIMARY CONTACT: ❑OWNER k31 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �ys _�j$'�(- $'/6$ <br /> J O✓� �.�L�+E'�►^ CONTACT EMAIL: ` �,y��.5��,Q_Ct,r-LcsyL ,,, ' <br /> 1 . (�Q7✓1'i <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: �Q,L.CC,W�. Contract Price of Work:$ � t�00 <br /> Proposed Use of Building: p�iN�b 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 ❑Chan e of Use <br /> DESCRIPTION OF WORK: (��„np�,�,�4�� �G,�,Ka .�Gk_ �pv:� :"+q . �c�L �J�'� : � � . <br /> s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): '��0� S� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration Repair <br /> #of Lisf of Fixtures #�f Lisf of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixfures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinai <br /> 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 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 No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the iniormation contained herein is true and correct.Work done pursuant to this permit must comply wdh <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.1 am the owner,or l 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 /> �� �� � 2'1 20('7 PERMIT# �'7 l�� -1 - DO� <br /> � ��, <br /> Own r/A orized Agent Signature Date (Revised 9/23/2016) <br /> � 4 �� � <br /> ``�\ 9/ ,<�'� <br />