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"41P-' PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN/SPRINKLER l DEMOLITION <br /> /:/44"/'' --44 CITY OF EVERETT PERMIT SERVICES <br /> '' ' 3200 CEDAR STREET,EVERE f t,WA 98201 <br /> (P)425-257-8810 [ FAX 425-257-8857 [(E)everetteps@everettwa.gov I www.everettwa.govlperrnits <br /> (Blue or ISlack,l�ett;0th t.;:- * `��......_.. PROJEtT tote INP0�t1Y/�i"t`)r�?i/ ' . ' 4.: B ..�.. <br /> PROJECT SITE ADDRESS: zq l 6 5 rte'7-W `- 7- /G/ 13 'JPROPERTY TAX#: O 4 $ 47 714 1 Ire' b <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> „..1i,„;'-' Co HTA '> f ilittli0010t+1 ,.; ice,> ;, <br /> OWNER NAME: 11,1,V tl r'r-c tt9 E �y¢,At Ai-er3t„v t:44 TENANT NAME(If Commercial): a.tt.eE,3 /V6-rt.4)c)n,& <br /> OWNER MAILING ADDRESS: STREET 2,f j 6 C7"4¢ gtrY- <br /> rf <br /> CITY •" 1ertr STATE 4)4 ZIP e Q I <br /> r40 <br /> OWNER PHONE: JOWNER EMAIL: <br /> CONTRACTOR NAME: Q..d-r f{rora 0 i- 120-4..-t- ,may 0t.t)t.G.tv-s <br /> CONTRACTOR ADDRESS: STREET G( 10 Q I 2rn "4-01.5- 5 <br /> CRY 5-&--A4-77-4.f:' STATE 1414 ZiP 4 <br /> CONTRACTOR PHONE: 266 .724 •C.)4'e/-4) _CONTRACTOR EMAIL: R,t G.t-'t D t 12,.r ti oG G.GO Wl <br /> CONTRACTOR LICENSE#(REQUIRED): 2..T 14O® +4.6 SVCQ r` CITY OF EVERETT BUSINESS LICENSE mC(REQU IRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 7-0'6 • '.t se, a. y” 3. }t. <br /> (2.3441 4 et-0 W.a 7-14 CONTACT EMAIL: /2.f. f-1+-r46,3 e p�'.7"f—/' "S't, ,ai3,1,40,1 <br /> 4 T A USLCT 400.40 !,. CATIO _ <br /> Existing Use of Building: Contract Price of W.rk: �G3't , <br /> Proposed Use of Building: Heat Source; OGas •—'- <br /> Building Type: ❑SFR-Detached DSFR-Attached °Duplex °Multi-Family-#of Units: °Commercial °industrial <br /> Type Project: ©New DAddition ❑Remodel ❑Repair OT.1, OSign OSprinkler °Demolition DChange of Use <br /> DE RIPTION OF WORK:fAl. r.4'j "t,,,./z4 "44(074_, 406 .0/1 E 5 t C,e e, c„ <br /> 5'5s'S.7"-e- , 5r4.-Apo .4 c.QBE ,s W 6—f416"7-6-1,—, <br /> AS • ED BUILDING PERMIT#Of applicable): <br /> r MECHANIC .. I. .:, AP*ICATIoa! ,' .m 1MMiro 'RMI 'APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New _Addrt Alteration !Repair <br /> #of List of Fixtures #of List of Fixtures #of List of fixtures #of List of Fixtures <br /> Fixtures Fixtures 1'Gtturea Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 SYSTEIYI 4 <br /> heroical Water t / 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 /> Budding Official before being authorized under any circumstance.I am the owner,ori 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 78:27 RCW and 298.200A WAC. <br /> Q_Alcsic--1,,,L-k_ City of Ever�ett{O�cial Use Only <br /> �� PERMIT#1, /l/ _n - vS — O A i1Owner/Authorized Agegesture Date (Revised 9/23t20/6) <br /> k <br />