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r ' <br /> er.. ,... PERMIT APPLiCATiOl l <br /> BUILDING 1 MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> _ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> (Blue®r black Ink®.nly_Ptease) . .pROJEtaT-trrk INFORMATION • - , . <br /> PROJECT SiTE ADDRESS: 65_0( 7 cd A✓G1�tiv{--- PROPERTY TAX#: 0 y/O 2_0 450 ZMO ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . ..CONtAcT.INFORMATION . .. . . - . ...• • • • .. <br /> OWNER NAME: a v', l.l -�le(Zt) °lira vA-t LLL TENANT NAME(If Commercial): <br /> el' tre o-. <br /> OWNER MAILING ADDRESS: STREET '•� 90(� � Q� <br /> CITY I✓�/I� ��,,S,T(A�TEE, &Altp),t, ZIP (tJ 20 <br /> OWNER <br /> HONE. .., 7.5-? 7 l'lPj .............. ............__ OWNER EMAIL: .°J. + ^.„C',„..,. . ha <br /> .. ., ,..,...._ _ .......... <br /> �� .I <br /> CONTRACTOR NAME: Et) Z.C.a U 6?`6 rTtrr c $'t - <br /> CONTRACTOR ADDRESS: STREET --I 2-0 Pel AUtir <br /> • <br /> CIT( t2(. tr1— STATE LAI A- ZIP dtS2ot <br /> CONTRACTOR PHONE: 4 25-2.c 2.-3/iq • CONTRACTOR EMAiL: M,� (vim g5/110,4 <br /> CONTRACTOR LiCENSE#(REQUIRED): COGY2(s jS 02.2.0 r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C1(j-7 55- • <br /> PRIMARY CONTACT: 0 OWNER &CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: 4 75-25-2>,//9 <br /> IAO 06 CONTACT EMAIL: t,A letalt & (ej ,Qv-. <br /> � ff <br /> BUILDING PERMIT APPLitA`i'ION <br /> Existing Use of Building: 1AJ 0 �Q` G13� Contract Price of Work:$ 1(1 76 <br /> Proposed Use of Building: NO Heat Source: ❑Gas L3 ectric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi Family of Units: C�Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign CI Sprinkler ❑Demolition ❑Change of Use <br /> DE CRIPTION OF WORK: l <br /> 0 (Act u - RTU .)c ®S 0O D v Mu ovic to-c" 2 3 p ci c1-4....95 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :NIECiIAWCAI,.PEftiIJJT AAPGICATI®N . . . . PLUMBING PERtifiIT APPLICATION <br /> Type of Project: _New Addn Alteration f Repair Type of Project: _New Addn Alteration Repair <br /> #of List of Fixtures °f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> f 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 /> Number of Heads — _ i <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.lam 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Zi_q___(t4 <br /> PE k.s0� ....O& I <br /> Owner/Authoriz ntSi aturee (Revised 5/20/2016) <br /> .i."7--') <br />