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PERfilill'�PPL.IC�4,`fBON
<br /> �lJELD{NG I iitIECHANICAL/PL.l7Vlid�[Y�l�I S(GN/�8�R16+�I�LER 1 DE�IiOLI�'10�1
<br /> C1TY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everefteps@everettwa.gov� www.everetfwa.gov/permifs ,
<br /> (�lue or�Ia�k Ir�le�.�Igi.�tease) � P�����`I`�I`P�It+l���lll1,�`�I�N -. . - . � . .
<br /> PROJECT SITE ADDRESS: ��� K.�/���G� PROPEI2TY TAX#: L7�, `'Z�✓'
<br /> LECAL for new construction: Short Plat/subdivision Lof No. {attach copy of long fega(description)
<br /> . - . . .. . . .. .
<br /> . _ � . � .��W'I'A,C`P.IfV�'O��ii,�`PI�N - . � . . . . .
<br /> OW[dER IUAME. ��� ��J�i (� TENANT NAM�(If Commerciaf}: ��{%�.
<br /> OWNER MAILING ADDRESS; s-rReer �j ���'�J
<br /> cirr � STATE G10� zia �
<br /> OWNER PHONE: OWNER EMA1L:
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<br /> GONTRACTORNAME; CUI�Yc.C�uc�,� �1Tta'T(-� �a$'���Wt,61�-
<br /> CONTRACTOR ADDRESS: s-rReer °Z I°� �l� �cU�
<br /> IN t✓UriyL�r STATE �{/.�- ZIP (��'�
<br /> CONTRACTOR PHONE: �°Z��°��2 P`�(I • CONTRACTOR EMAIl.:
<br /> CONTRACTOR LICENSE#(REQUIRED): �(J�(�.�j�p�,�v CIN OF EVERETT BUSINESS LICENSE#(REQUIRED): (��j �'
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<br /> PRIMARY CONTACT: ❑OWNER !l�4.CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACF MAME: CONTAC7 PHONE: ��g_���a�O�C�
<br /> �/�w� �� � CONTACT EMAIL: ����? ��a� �
<br /> - � . - � .. :. BUILDIN(�'PERNIIT�iPPLIC/�1T10N � � . . , � � .
<br /> Existing Use of Building: � ta� Contract Price ofi Work:$_ `�� ���
<br /> Proposed Use of Building; � � Heaf Source: �1Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Defached CISFR-Affached ❑Duplex ClMulfi-Family�#of Units: ❑Commercial ❑)ndustrial
<br /> Type of Projecf: ❑New �Addition ❑Remodel �S(.Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTfON OF WORK: ��,� �t,� „f," ,� �� p_ � �.Z ��ft�'�C���, ����� ��
<br /> ir.e��u�r�� 94yi�- �Y
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<br /> ASSOC(ATED BUfLDING PERMIT#(if applicable}:
<br /> ' .M�C�IANIICAL.PERIVIIT A�PLIC:ATIOM � �L,I�M�IM� P��M!`r APE�L.I�A,7'I�M � '
<br /> Type of Projecf: _,New_, Addn A[feration L,Repair Type of Projecf: _,New ,_,Addn Alterafion _Repai�
<br /> #of List of Fixtures #of List of Fixfures #of List of Fixtures �°f List of Fixtures
<br /> Fixtures Fixfures Fixtures Fi�cfures
<br /> A/C—Air Handling Unifs Heat Pump Toilef Backflow Preventer(Inside Bldg)
<br /> Forced Air Sysfems Unit Heafer Bafhtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Founfain
<br /> Wafer Heafer Refrigeration Shower F'loor Drain
<br /> Gas Fireplace Wood Stove Kifchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Ofher: Clothes Washer Medical Gas '
<br /> Range Hood Wafer Heafer Ofher:
<br /> Exhaust Fan Sink(Service/Bar/Mop/efc.) Other:
<br /> .��fP��i[�9��.�R/��JI�P����7�P� SY�Y��l9
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•l have reviewed this application and confirm fhe information confained herein is true and correct.INork done pursuant to this permit must comply with
<br /> cur�ent federal,state,and local faw.The granting of a permit only authorizes approved wo�k and no deviations fherefrom.Deviafions must first be authorized in wrifing from the
<br /> Building Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this properly to pert'orm the work for whrch application is made,
<br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> Cify of Evereif Official Use Oniy
<br /> � PERMIT#�,�,� ��0�� �^�
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<br /> Owner/AuEhorized Age Si afure Dafe (Revised 5/20/2096) 1 �j-
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