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<br /> �131�.[�IiVF 1iiECHA�IIGAL/ PLUME3ING / Sl�i�l �RII�aCLER/ D�MOL1TIOi�
<br /> CITY OF EVERETT PERMIT SERVICt�
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permifs
<br /> (�lue or Black lnk Oniy P1e�se) P.RO.IECY 51TE IP7FORMA'TIOId .
<br /> PROJECT SITE ADDRESS: �� �,e.g�n/l.e,s..i,sfc (���.�I L7,� . PROPERTY TAX#:L�O'�QgUC9 IG�1 CO
<br /> LEGAL for new construction: Short Plat/subdivision��/fA(�e1�S�-L�5t'Lot No.Z��j (atfach copy of long Iegal description) /��{,a.�,���
<br /> CAPlTACY INEOEtMAT10I�D
<br /> OWNER NAME: S�o c�`..� (��u� �.a.�f..s� TENANT NAME(If Commercial): �v� �Lf �,� ,,�E�R,�,..,
<br /> OWNER MAILING ADDRESS: sTReer /�, � �j�,y� ��j
<br /> CITYr'/(,� �� ���U STATG G(J�iI- ZIP ��Z.7�
<br /> OWNER PHONE: �Z� - 3ST^ '7 33'S OWNER EMAIL:
<br /> CONTRACTOR NAME; QwN�,�
<br /> CONTRACTOR ADDRESS: sTREr_T /� � /3�� /S�
<br /> CITY�I�� �C� /��� STATE W�' ZIP �� L� 5
<br /> CONTRACTOR PHONE:�ZS�jSrj- ''3'3S CONTRACTOR EMAIL: �,// e,,�/ Gc,�g f r....�,G��r�J .�cr4
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> _....� ..,�_.. __.:�..__ _.,__...,: _ .- .,.�.. ,._. ....__:_... . . ..:.._ .._... ...._..-. ._. -., ........ ,...:,__... .... ._�._ _.: . _.._,..._ . _. ...._._ . ..::.._.:._.... .:...... ..... .._�::..
<br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR C�J'OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �/ZS- Z�O - �7 7�'�7
<br /> � ✓��g-�-�' CONTACT EMAIL:�✓,�,6��,.�� `j,aZ�a.w• •wi�n/�rJCYe.c�.ccr
<br /> ` : ` BUILDING PERMITAPPLICATION
<br /> Existing Use of Building:Z,✓o/..e.S�,.-��.o-� Contract Price of Work:$ /� � 7 �r •�. G
<br /> Proposed Use of Building: ,��u �.,,,�. � Heat Source: � ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Aftached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial C9'�strial
<br /> Type of Project: ❑New ❑Addition ❑Remodel C�P'�air ❑T.I. ❑Sign ❑5prinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ���Oia.i.�.. �/�-�. c�s�.+-•-�� � C�'�GC (�c..c. ��
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHA.NICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of Lisf of Fixfures #of Lisf of Fixfures #of List of Fixfures #�� List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixfures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systerns Unit Heater Bathfub 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 Heafer Other:
<br /> Exhaust Fan Sink(Service/BadMop/etc.) Other:
<br /> SPRIIdKLER/SUPPRESSIOId SYS7'EM
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.'//�ave reviewed this application and confirm the informafion contained herein is true and correct. Work done pursuant fo 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.l7eviations must first be aufhorired in writing from the
<br /> Building Offcial before being authorized under any circumstance.1 am fhe owner,or 1 arn authorized by the owner of this property to perform tl�e work for which application is made,
<br /> and l comply wit�be-St�Coiifracto;s�aw 98.27 RCW and 296.200A WAC_
<br /> � - / Cify of F_veretf Official Use Only
<br /> �_� �
<br /> � PERMIT# 1 f
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<br /> OwnerlAufirorized Agent Signature �_ // � Date � / (Revised 5/20/2096) l � I�/``
<br /> .✓'`- /L' .�_._'7 `'I' '"'�. C-- C..,� /�C �../ : �.��C...`_% ,l V
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