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PERMIT APPLICATIO(� <br /> BUILDI�VIECHANICAL/PLUMBING/SIGN ��INKLER/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 /> PR�JECT SITE 1NFORMATIQN <br /> PRO��T SI E ADDRESS: ,� PROPERTY TAX#: a,•� ����,�� <br /> 6�' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ° GONTAGT.[NFQRM/�'FtON - _ _ <br /> OWNER NAME: � ' .��� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREeT �`'�/,� `f3'/ � <br /> CITY �� � � STATE � ZIP �� ��� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTReer <br /> ciTv srn� ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): V�il �pV <br /> . ,. , , . _ _ <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify)y �e�����'/ �'��� � <br /> CONTACT NAME: CONTACT PHONE: r <br /> � � �� <br /> ��? �� �� CONTACT EMAIL: � � � � s � <br /> r��� Bt���.�l�L6'�Et�M��,�F���iJ���Q� <br /> ,. . , . <br /> Existing Use of Building: ,�w Contract Price of Work:$ � � <br /> Proposed Use of Building: „�� ����.� Heat Souroe: ❑Gas �ectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: �c� ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESGRIPTION OF WORK: � �����r��" ��� ��.y <br /> G!/ � <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECC�i`/�.Nf,�tE'PEF�IMiI'�'�PL�Lf£"A�t�l�l ; .`; l��.�MBtl�iG PER1�1117'RPRE.�EA�[QI� ; <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of ��st of Fixtures #°f List of�xtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg} <br /> Forced Air Systems Unit Heater Bathtub Urinal <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(Seroice/BarlMop/etc.) Other: <br /> SPRi�f�E.Eit�SEJPE*�i€ESSIQN S1�S'FEM: <br /> Number of Heads <br /> ACKNOWLEDGEMENT:!have reviewed this application and confrrm the information contained herein is true and correct.Work done pursuant to tiris permit musi comply with <br /> current federal,state,and local iaw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing irom fhe <br /> Building O�cial before being authorized under any circumstance.l am the owner,or l am authorrzed by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> PERMIT# <br /> � o �-02 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> �� <br /> �_...- �/� <br />