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PERMIT APPLICATION <br /> --A BUILDINC�CHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> A 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 1 www.everettwa.gov/permits <br /> ii M, . § ; ; EA . „ PROJECTSITE1 FORMATION r= ,. . . . zZ <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ina' . .. . N B fi ,f, CONTACINFMcATION <br /> .. ,. , :j4 :-tr* t . . ' aem <br /> ! <br /> OWNER NAME: -J 7 0 1-1-4-w ' <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET(23 O '� -4 fo . ri, �� /�`JQ� <br /> CITY e'1/ Z6^���t/errf-- <br /> STATE �/ / i ZIP <br /> _ ......._ ._.,., .,., . <br /> OWNER PHONE: 0/2.0/2. t5 7��' ` ....OWNER EMAIL: <br /> CONTRACTOR NAME: A 7--:- ...P.4,--r. �/U� <br /> CONTRACTOR ADDRESS: STREET /740 , .,_,Z.._ � i 6Oji <br /> 4 � <br /> CITY C /L%�`L ' :Ce i STATE Of, ZIP y—�� <br /> CONTRACTOR PHONE: S2 ` y v/Y6_-- CONTRACTOR EMAIL: �� �_..<,a,G' <br /> CONTRACTOR LICENSE#(REQUIRED): s CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):to-go(p <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM CONTACT PHONE: a:/fr.‘--- ,'7' <br /> / i � 4Y€ G� - CONTACT EMAIL: %1� .x-`-�`/���� ' <br /> m z "� _ :-�"�'"�` . '�` '� '4 °" y - - .` �` 'c�-�-rte, s`, _ <br /> } , , .,to ., ;BUILDING FERNY APPLICATION mmmmm: � �`z . _ .3� <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: i <br /> QonGtrit 'OW-1_ n Cbo tit I 11 cLt'1 , C.F. 4 x Z 3.S <br /> t) 11-q Co 43 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> , ,MEGHANI,CAL;PERMIT APPLICATION r PLUMBING'PERMIT APPLICATION, ' Y <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 /> 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 /> _ <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 /> liSPRINKLERa/,'SUPPRESSION SYSTEM,h`{;s, <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.I am the owner,or lam 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 /> g4/`G�/ PERMIT#-0 1(-00 -01 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />