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in <br /> 11° <br /> BUILDINU ) MECHANICALS PLUMBING I SIGN)SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> illiiii.grr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT, ••�� SITE6INFORMATION <br /> PROJECT SITE ADDRESS: 56(3S ��fl )tE-W Wail eteleli- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SCO-Et 4 S 2�YJnic 1,1 a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ` 5015 &tj it i(, Wm <br /> aip q <br /> crY Q, ,-`1 STATE IA.2a ZIP fg9,0 3 <br /> OWNER PHONE: 20(0, e3' q— 0.7e I OWNER EMAIL: <br /> CONTRACTOR NAME: 04$--- (fs( Corysfr Wcv - In ^ e�j(!/lJ k 1 <br /> o9c <br /> CONTRACTOR ADDRESS: STREET Got& I itq m r SE - 1` v ,;,9, P .41 _® <br /> CITY c no 11‘.DV✓l 1 .YI STATE ZIP Q / ' '')00 <br /> CONTRACTOR PHONE: Z. 345— X4'27 CONTRACTOR EMAIL: i r / �/r it i i,,)),,Q/1� _' <br /> CONTRACTOR LICENSE#(REQUIRED): r ' r'�313F CITY OF EVERETT BU NESS LICENSE#(REQUI- DO /1 i I ,e) <br /> r <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) "��1'"1I <br /> CONTACT N CONTACT PHONE: 90(0 sq c-7(La-5) ,41-7-7 <br /> c-1.6-14 112\id CONTACT EMAIL: il e cis roll setreee_ aso <br /> V <br /> BUILDING PERMIT APPLICATION Teti y S_owl <br /> �+e JO <br /> Existing Use of Building: slew.. Contract Price of Work:$_2A �©5 V <br /> Proposed Use of Building: .7e/C Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> 6.DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration - .air Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of st of Fixtures #of List of Fixtures #of List of Fi - es <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Prev- ter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinki : ountain <br /> Water Heater Refrigeration Shower Fl.- Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal rease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes D ' Hookups Other: Clothes Washer Medical Gas <br /> Range •od Water Heater Other: <br /> Exh-• t Fan Sink(Service/Bar/Mo. -tc.) Other: <br /> S4RINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> \ 1 � PERMIT "--,. <br /> lk <br /> top) <br /> OwnerAu I i ed Agent Signature Date (Revised 9/23/2016) r71— <br />