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1 IIII <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> __M_ __ CITY OF EVERETT PERMIT SERVICES <br /> _ _ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits . <br /> (Blue or Black Ink®.nly.please) PROJECT SITE INFORMATION . <br /> PROJECT SITE ADDRESS: (ii V Ph.s.)2E:> G PROPERTY TAX#: 00 0216030000 "" G� z3 <br /> LEGAL for new construction: Short Plat/subdivision ( Lot No. (attach copy of long legal description) <br /> CONTACT.INFORMATION <br /> • <br /> OWNER NAME: (f 2-44 aj'l 0/ /Jolt- TENANT NAME(If Commercial): t(2t4'7 D boot <br /> OWNER MAILING ADDRESS: STREET II 17-6 22. CO 41- <br /> CITY a)t 4l ` STATE WA ZIP Is,io / <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C UCAG( AJ 67?rTtC �j¢EEa T f 4CTA-c <br /> CONTRACTOR ADDRESS: STREET '24 2.- ) [Act CIL AV 0" <br /> • <br /> CnY E.+ULi MOTT STATE (11.A. ZIP ie.201 <br /> CONTRACTOR PHONE: 4Z5-2_5 2 P3(l q-f • CONTRACTOR EMAIL: 14.4,141444,@ c%14w/t, <br /> CONTRACTOR LICENSE#(REQUIRED): tcV4 SS o2_0 T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (-)b"7 e,I 5'5— <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: Li 2 5.-2-5-2_' 19 <br /> M A jO4A/8 CONTACT EMAIL: /. ê 055/4a.)4,-4 a b'i <br /> • "/ • BUILDING PERMIT APPLICATION <br /> Existing Use of Building: da ettea e I Contract Price of Work:$ 30,000 <br /> Proposed Use of Building: 14 0 eAlotAX 6 Heat Source: 11Gas ❑Electric ❑Other _ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ClMulti-Family-#of Units: $Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ReerAC-6 RIO 15 IA/tril 5470.6, <br /> c(3 ,e p,4•i j tc*q'L{ <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 #°f List of Fixtures List of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> `Z 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 /> 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(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 lam authorized by the owner of this properly to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3/3///7 PERMIT#M 0 DNt^r 003 <br /> Oar/Authorized nt Signature Date (Revised 5/20/2016) 0IZ <br />