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QM4-P <br /> -- EMIT APPLI-' .TIO <br /> /11111101 — <br /> 114 <br /> ECHAN " ,LUMBI SIGN INKLER/DEMOLITION <br /> CITY w"-, - PERMIT SERVICES '` <br /> `4011 <br /> ' ' 3200 CEDAR STREET,EVERETT,WA 98201 Cd✓,,,,,.,«c,c\ t <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits jl vwr 9I <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IBJ J( J(�r'C- wri,1 <br /> O(PROPERTY TAX#: C J3 O J V) i') <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:-.170M M('Q‘...),l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:TTSTREET CO PV ;er\ k nom' ick'C-•to k <br /> CITY ecet i- STATE km A ZIP <br /> OWNER PHONE: 42icip OWNER EMAIL: pa ��"�7 YYZ ,,c VV® 1LG <br /> S 2i <br /> c`- 0 rY,pt r� Ceanero I. Cnc eke 1 LE- <br /> CONTRACTOR NAME: i <br /> CONTRACTOR ADDRESS: "I STREET 2.i l Q Ma( r $* <br /> CITY a et- ISTATE VU ZIP l 11 1) <br /> 4-2 ) <br /> CONTRACTOR PHONE: 6` l"1 C IT J <br /> 1 CONTRACTOR EMAIL: LC[1 e( Oit r p\('o] i • (njy) <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ()I4 05 <br /> PRIMARY CONTACT: IC OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (� CONTACT PHONE: 4t2 c. L XPD 0,J7-� <br /> e `�I 7\[ M C u 1�y CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ft)1 '',J Y (1) S[Contract Price of Work:$ 1 01 000.6% <br /> Proposed Use of Building: [q is j�, vI cc, u'`iU seat Source: ❑Gas ❑Electric Other 11e0a-ctA Ip <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ,Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition WRemodel El Repair ❑T.1. ❑Sign ❑Sprinkler IitiDemolition 151Change of Use <br /> DESCRIPTION OF WORK: 0 ..,„,•i ) ir TV ' TG fi rI -- J i • i ' w "1"_ ' • 4- <br /> _y ,1-a\e„,e .......e. - ..= .m� -e . - <br /> Vhii.t✓wzz,ki 4 ltivvA.N9 1 5 <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 List of Fixtures #of List of Fixtures #of List of Fixtures of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet ,____ Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> / Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> V\e/WdlefViater^N.4 / Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal t/Grease Trap LAG d �d� <br /> ,/Gas Range Ducting Dishwasher Roof Drains J <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> GQi A..Floed�- (i VV-'oc J--- ,/Water Heater Other: <br /> VU' Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I 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 Official before being authorized under any circumstance.I am the owner,or I 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 /> -1 lilt:I. . . .1 C2- / X 1112- 00 <br /> LI <br /> Own-r/A horize,\gent ignature Date (Revised 9/23/2016) <br /> iI/ <br /> �`7/ <br />