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PERMIT APPLICATION <br /> BUILDING/IMIECI-IANiCAL 1 PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> 0411 _____ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 ((E)everetteps@everettwa.gov( www.everettwa.gov/permits . <br /> (Rltie®r Black Ink Only_Pleasie) . PROJECT.SI`P INFORiViATION . �t . _ <br /> PROJECT SITE ADDRESS: 'iWO MC►y`f!/1 6/4 v /DO PROPERTY TAX#: 'L0®i 02Lb7jCr 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . .CONTACT.INFORMATION . •. . . - . • <br /> •OWNER NAME: LA84) c- L!� TENANT NAM (If Commercial): ,jg/in/. 1W <br /> OWNER MAILING ADDRESS: STREET 2.390 M‘11411 t/ 6 ezif- Av{n . <br /> CITY eV ei.,e ► STATE WA ZIP 9©u/, <br /> OWNER PHONE: (o— Z72-53-BC OWNER EMAIL: <br /> CONTRACTOR NAME: C v ,(4 AJ 6 Tin-Te: Er✓` ' <br /> 6iA-c <br /> CONTRACTOR ADDRESS: STREET 2I 20 I/� l ft,C, ACV Gr <br /> CITY F✓V C(2-tr T STATE w 4- ZIP Et S20( <br /> CONTRACTOR PHONE: 4'2-5-2_52--'- //1-1 . CONTRACTOR EMAiL: 'yi4a,a 6,54,/a'A t cow <br /> CONTRACTOR LICENSE#(REQUIRED): e()Q2- 4'S a220-I' CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): C3 6'7 Ci 5-5- • <br /> PRiMARY CONTACT: D OWNER E&CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4'2 5---25-z-->//9 <br /> / IVer CONTACT EMAIL: Attke e.r u,�jrc,,. <br /> BUILDING PERMIT APPLICATION . <br /> Existing Use of Building: tft 1 Contract Price of Work:$ /61 moo. <br /> Proposed Use of Building: No 64410405Heat Source: I�Gas [(Electric 00th <br /> Building Type: SFR-Detached ['SFR-Attached ❑Duplex ❑Multi Family#of Units: �£ommercial ❑industrial <br /> Type of Project: ❑New DAddition ❑Remodel n!-Zepair DT.I. ❑Sign ['Sprinkler [(Demolition ['Change of Use <br /> DESCRIPTION OF WORK:, <br /> P� IJ L t/410k-e.12,7 Wet Pi) AND a d 50,t/e &v ra 1. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> M@ CWAPIIOAL.PERI{(IiTAPPLICATI®N • • PLUMBING PERMIT APPLICATION : . <br /> Type of Project: __New Addn Alteration A..Repair Type of Project: New Addn Alteration _Repair <br /> It ofList 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 /> 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.tam the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1--\/\04111 PERMITvn06,, izi <br /> Owner/Author'1. gent Signature Date (Revised 5/20/2016) <br /> j(� <br />