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0-1:14477PERMIT APPLICATION! <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J el,jyi,it —15 OVA 444„, <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 412A CpmI1444/ ''D_Q (� <br /> CITY ET 1./ <br /> STATE t ZIP 9 O(i <br /> , <br /> OWNER PHONE�2A( ) CI I 0 r-- 1 3 Ss OWNER EMAIL: \GX►'LQ,s0 ma+ 2,€,, efl_ . C,,,�/�}-� <br /> CONTRACTOR NAME: kV AOU.rl'lb1�h9 LLC_, �•J <br /> CONTRACTOR ADDRESS: STREET 5401 J 1 t a I\.- , , <br /> crn' v i l STATE WC,J ZIP 9.82:76 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ape)t(O <br /> CONTRACTOR LICENSE#(REQUIRED): 49 0 �'PL q O 3 L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 34 <br /> PRIMARY CONTACT: 0 OWNER ,>J CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: \"r 'FA j ve,y OI,-. CONTACT PHONE: JC4 s )3E7-- k5D <br /> "Debbi °L R5,sc (J CONTACT EMAIL: d'El°i,r�.Cl.e o t t U f'7 i l,(;YVI.b <br /> "Di v c ,CP kY) <br /> lJ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ _UD <br /> • ov <br /> Proposed Use of Bu' ing: Heat Source: ❑Gas )lectric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �.❑RRepa�iirr ❑T.II.. Q❑Sign ❑Sprinkle(r���❑-{Deemmolition ❑Change of Use <br /> DESCRIPTION OF WORK: 'WW1–€-12- <br /> , � We ` r C.. 1`�e..19L rnEil <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List 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 /> 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 /> an omply with the State tors Law 18.27 RCW and 296.200A WAC. <br /> �( City obas___02,0 <br /> fEverett <br /> OfficialUse Only <br /> 4 1C/i�- ��D/�t PERNJM i <br /> ner/ uthorized Agent Signature Date (Revised 9/23/2016) <br />