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PER�iBT A��LICATIOI� <br /> ��OLD9Y�C� /f�i��&-9�NICA�./ �9�19V��1�� /�e�N /S��Bi�I��E�/ ���90L��'IOP� <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� ww4v.everetfiva.go�/permits <br /> {�9u��a�I�I�ek 0n��r�8y�9e�se) ������`Q'���'� GQd���MA`1T�ON <br /> PROJECT SITE ADDRESS: �� �f�• �!ld.���1�'��} V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �Ot�`�AC"P IN�O�IVIA7'I�B�1 <br /> OWNER NAME: 7EiVANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr <br /> � CITY ' STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: '�j'j�(�2� J � <br /> CONTRACTOR ADDRESS: sTReer <br /> C�7y STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY COiV'fACT: �OWNER ❑CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BU9LDING PERMIT APPI�ICA'TI�Id <br /> Existing Use of Buiiding: Contract Price of Work:$ �S�� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached �SFR-Attached ❑Dupiex ❑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: <br /> "' � �OR �`�to �� �� . �''�� . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECf1ANACAL PERM17'APPLIC�4TION PLIJM�ING PERMI'!'APPLLCATION <br /> Type of Project: _New_ Addn _Aiteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fi�cfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Sysfems 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 j Other: _ �j�� Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/BarlMop/etc.) Other: <br /> SPRI�IIK�EIt/SIJPPRESS10td SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this properfy to perform the work for which application is made, <br /> and 1 comply with the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Evereft Official Use Only <br /> ;;�' '� PE MIT# <br /> �-'���.��� �� -C�53 <br /> O er/Authorize ��gent Signature Date (Revised 9/23/2016) <br /> �v�. ��-o� -- o2Cv <br />