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' I PERMIT APPLICATIO III <br /> BUILDIN�/ MECHANICAL/ PLUMBING /SIGN)FRINKLER/ DEMOLITION/ � CITY OF EVERETT PERMIT SERVICES <br /> �� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> LABlue or Black Ink Only Please) kPROJECT SITE INFORMATION <br /> / PROJECT SITE ADDRESS: 12DO \ \kQv Cclue_ .4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION 1-o--14- ( -!_ <br /> 14191q OWNER NAME: � Ch i cK S('Qe' 6‘ TENANT NAME(If Commercial): `�j S e- v <br /> L <br /> OWNER MAILING ADDRESS: STREET 0q [-few lt"/L � <br /> 7L lave 7 2 6- 20 Cq (9 0 <br /> _. CIN �'" 'el e("+ STATE X64 ZIP gOP20/ <br /> OWNER PHONE: 7,6 2 51. O' 'NOWNER EMAIL: <br /> CONTRACTOR NAME: 9 S CCho\i.\\co,' �O\U <br /> CONTRACTOR ADDRESS: STREET (N '�(2_,(47,0 \.' , )p sse__ =0 /� <br /> CITY STATE W 1r ZIP C/PeOtJ,p{ <br /> CONTRACTOR PHONE:L.2 5 2sq (44 Lq CONTRACTOR EMAIL:PSS "I CGU V'l Ca)49 n \.CO ' 1 <br /> Y - <br /> CONTRACTOR LICENSE#(REQUIRED):>i Got/- 1.67252. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) '� t P' <br /> Q <br /> PRIMARY CONTACT: ❑OWNER 194 CONTRACTOR 0 OTHER(Please Specify) 1.12,LAA , <br /> CONTAT NAME: CONTACT PHONE: L/25 2 q �0 f q , /nn <br /> �� CONTACT EMAIL: PSPIMe ctiaJ►[Cc (0-9 9pg1 I. (b m. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 7,®Oct <br /> Proposed Use of Building: Heat Source: ❑Gas 0Electric1 Other i 6- <br /> Building <br /> Building Type: OS/FR-Detached ❑SFR-Attached ODuplex ❑Multi-Family#of Units: CpCommercial El Industrial <br /> Type of Project: L1dNew ❑Addition ❑Remodel DRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> kDESCRIPTIONOFWORK:Th54.A.0 ('"79 i9'r,e CCode - 0 )(401 CCp4e,se1 o0-f-.St'A. g I—U/o1pk�A-/ <br /> Coll "ti\slae'1 QtAq\v\l\f" \tAt $e-\- / <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 7-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 /> Fixture Fixtures Fixtures Fixtures <br /> A/C-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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> YN <br /> i ( i ,^ PERMIT 6109 <br /> 0 ' 4 L5-- Ill <br /> Owner/Authoriz=. Agent Signature Date (Revised 9/23/2016) <br /> CO <br />