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PERMIT APPLICATION <br /> elliBUILDINE CIIANICAL I PLUMBING/SIGN mRINKLER I DEMOLITION <br /> �,�s J� CITY OF EVERETT PERMIT SERVICES <br /> s - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1-4 j 0 0 L'(M p le, Dia...We' PROPERTY TAX#:0 034 1400000 A pi Uu,,.,,,,,, <br /> LEGAL for new construction: Short Platfsubdivision SEE Alt ea-F Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C Try 0 EVEy.I 7n--* TENANT NAME(If Commercial): T Mbgot Le- <br /> OWNER <br /> e{ - <br /> OWNER MAILING ADDRESS: STREET 37_04:s ce h i k'(L STtr_. : r-s t x , • f1/4/0,2_14„ bA <br /> Orn EA/.'2i1=Tr" STATE W ZIP C( Z,()1 <br /> OWNER PHONE; 47_. .--7 ' -7. OWNER EMAIL; MaoV c L e @ esti ,c-0-4-140. .re <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIREQ); )C X_.J (p)E) CITY 4F EVERETT BUSINESS LICENSE#(REQUIREIN: p.(231/4{- <br /> PRIMARY <br /> 2 `-`":1PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) T MO et Lt. 1 C 10 1 .E !.. <br /> CONTACT NAME: " <br /> ` CONTACT PHONE: ZOb3Sl-Og93 <br /> M - --0 (j l�6 t. CONTACT EMAIL:•i-o `zt]�/I Asoik.\c4 TO,�+. ��� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: W i. i-eir- ADJA k,.., Contract Price of Work:$ S. .1r- - 4 10 <br /> Proposed Use of Building: 0,d,k v irL&e.SS ke,xe,com, Heat Source: ❑Gas ❑Electric her <br /> Building Type: DSFR-Detached DSFR-Attached DDuplex DMulti-Family#of Units: Commercial Dlndustrial <br /> Type of Project: ew ❑Addition ❑Remodel ❑Repairs DTI �❑S 0.jS�prk �a Demolition alC�ha;girse <br /> DESCRIPTION OF ORK: obikL cl7 ov , . 1 <br /> 0,,v1 -1ec-tic a.\ e4A --e.1e.pWovttL. vii l;tie.% #u be- rouk-td. '1v st'.a) 4-r- %) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N I k <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New _ Addn _Alteration _Repair T i• of Project: _New Addn Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List Qf Fnrtufgs Fixtures List of Fixtures Fi List Qf Fixtures Fixtures List of -- _res <br /> NC-Air Handling Units Heat Pump Toilet Backflow P nteF(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urina <br /> Gas Piping BQilar Lavatory(Wash Basin) .'...ing Fountain <br /> Water Heater Re ',eration Shower Floor Drain <br /> Gas Fireplace tood 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(Servic- ---rlMop/etc.) Other: <br /> SPRINKLE- 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.tam the owner,or lam authorized by the owner of this properly to perform the work for which application is made, <br /> and f comply with the State ntractors Law 18.27 ROW and 296.200A WAC. <br /> City <br /> l of Everettt nOfficial Use Only <br /> �~ I� of; 'T-/1�a fSlL„� PERMIT# <br /> 1 o `Y' a�� - <br /> OwnerlAuthori Agent Signature Date b-s-Za 1 e (Revised��016) <br /> C117" -- <br />