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PERMIT APPLICATICm <br /> BUILDING 1 MECHANICAL/PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' J 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: tt' Z-G1 tVe j�,e,V\ ‘,-)2/ eVeYe\'T 161°3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5 GA TENANT NAME(If Commerci I): 5'-'c ((..4 V V-V)\Ili► SGkww 1.- <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> e( <br /> OWNER PHONE: OWNER EMAIL: ic, a W" v\ fcc\e Q1l\i I \Q 5 eC1\56\A <br /> CONTRACTOR NAME'' C Coss 010 S 1 G" I� <br /> CONTRACTOR ADDRESS: STREET 164o 6 -1 9L L k4,1 <br /> `CITY (.,f 11/(V�JO OO STATE v V ZIP le) <br /> CONTRACTOR PHONE: (t{-L5! 4.4 6) �r CONTRACTOR EMAIL: Se+-I C SC'r044S\- ¶' <br /> .,.�- <br /> CONTRACTOR LICENSE#(REQUIRED): G to S.SS 314' /394-1)(A r CITY OF EVERETT BUSINESS LICENSE#(RE• IRE Di: <br /> PRIMARY CONTACT: 0 OWNER a(CONTRACTOR 0 OTHER(Please Specify) -' ' <br /> CONTACT NAME: 5 E `(trtovAtky CONTACT PHONE: (y, 4-4 t -4 4/ GI k C (.4 4 '" - 00 <br /> OksfEAS N4-;) CONTACT EMAIL: e v1 C t S e c-o` Yt tc- n c 1 . C: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of W :$ 2,(>64) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑O er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: 537Com ercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. 5ISign ❑Sprinkler a Demolition ■Change of Use <br /> DESCRIPTION OF WORK: \t..3s-v AILL.\Ivh A, 5tv\Ptd C.i\git\IsT oy` t " c-Av NT <br /> 1 S Tf..4cNNoy L t, <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 Fi f,res #of List of Fixtures #of List of Fi <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat P p Toilet Backflow Pr: -nter(Inside Bldg) <br /> Forced Air Systems U; eater Bathtub Urinal <br /> Gas Piping -oiler Lavatory(Wash Basin) D' 'Ing Fountain <br /> Water Heater Refrigeration Shower loor 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/B- op/etc.) Other: <br /> SPRINKLE' /SUPPRESSION SYSTEM <br /> IChemi • or Water I No.of Heads <br /> ACKNOWLEDG (ENT: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, .ate,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.1 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ii �pp City of Everett Official Use Only <br /> g 1 2--� V PER ,wO.3 _( <br /> Owner/Authorized Agent Si nature Date (Revised 9/232016) <br />