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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9820'I <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Biack ink Oniy Piease) PRa?�.iECT SIYE iWFi3R�iiFaTiOi�i <br /> PROJECT SITE ADDRESS: �J3 � SN�I 1iV��i(�( M�I�,�/U�� PROPERTY TAX#:o��(�'+.� '�UC%4�C'C� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (�t'LI(�� ����"t�(':�i F'i�=U �•r��-- TENANT NAME(If Commercial): 'j��(�( �'��i �S <br /> OWNER MAILING ADDRESS: srREEr�� S�(�I ��j�i��C N���/ �I�"� <br /> CITV ��/pi�/�� STATE y V� ZIP ��(� � <br /> OWNER PHONE: �}Z� ',��rJ�•U� OWNER EMAIL:(Y1�K�t'i`I�uLc:-LIR.I��I C.`' �!'t_I1liG�C(�W1 <br /> CONTRACTOR NAME: MI�hI(7N �I�i.G�I��t ,�"� `�'F1,�IN-C 5��1 � ItVU I�dfSC <br /> CONTRACTOR ADDRESS: sraeEr I���� I t"� ' �j 1L�(V+G <br /> CITY �`��u.�I' t�� STATE V V�T ZIP �p�r- . <br /> CONTRACTOR PHONE: %j��j '��7✓�;�(}(�j CONTRACTOR EMAIL: (Y�e'�I l0� 'C�S Vl(i�'�Ip��1t'sj C �/I .C'G►/ti�t <br /> CONTRACTOR LICENSE#(REQUIRED):j f-�(o��������� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):���(� �j�� <br /> PRIMARY CONTACT: ❑OWNER �S CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,��y(�--L�-�„t� _�(j,.?a <br /> �,�1���Q� ����T�i� CONTACT EMAIL: i'yl�/� t I�N�+�L����Y��iY1�S1� i✓1•C=Gi'V/l <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: '({�I l� Contract Price of Work: $�� � <br /> Proposed Use of Building: '((�L Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached �Duplex ❑Multi-Family-#of Units: `�ommercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. i n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> D��CItiPTIOh OF 6'VOi2K: 1 N5T/�� G("�`��►� I S�-�"x �'-5 zs" �� i�u,�n�.i���1�r�L� c#i<1rv+v�� <br /> LL;�iG1� V�fAU- Sl E:N � C.C�t�f r�f c�.t 1 c:i �E=�St"i1���- Ll i�C_l.lT <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: _New Addn Alteration Repair <br /> #of �ist of Fixtures #of ��st of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S stems 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 Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mo letc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein rs true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The grantrng of a permit only authorizes approved work and no deviafions theref�om.Deviations must first be authorized in writing irom the <br /> Building Official before being authorized under any circumstance.I am the owner,or!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 /> PERMIT# <br /> � !� �� :� 11 �� � - :; t ; ,��� <br /> Owner/A horized Agent Signature Date (Revised 9/23/2016) , <br /> /�/�./ <br /> .� <br />