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,., 000.40., <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION • <br /> ' � CITY OF EVERETT PERMIT SERVICES <br /> ,Iiiiiigi.. -- 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 /> 01146'6i Black Ink®.nly_Please) - . PROJECT S TE INFORMATION • _ . <br /> PROJECT SITE ADDRESS: /0 VOl 3Tv'/2etr4 49 (PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long leggy.- .iption) <br /> __ <br /> • <br /> - — _ _ ..CONTAC`P.INFORMATION • • • - `. ' . <br /> OWNER NAME: ` f fithejlrj, Q-60TENANT NAME(If Commercial). <br /> OWNER MAILING ADDRESS: STREET 81( 14442174010 <br /> circ I: BT11 tly STATE(Mk. ZIP VSlii 3 <br /> OWNER PHONE: ����, ,/�, OWNER EMAIL: <br /> CONTRACTOR NAME:, .E UIP.��C� Du._.,...51-14r 1C..._ �a((E�+I Wt.� c ..,, M._ ... ...,,. <br /> CONTRACTOR ADDRESS: STREET 24 2 , PAC,1� �() p� <br /> • <br /> CITY `�eri I ( STATE (,4,,./ � ZIP <br /> +� q�T7' , <br /> CONTRACTOR PHONE: 4-2-5-2-5-2.o3/t4 . CONTRACTOR EMAiL: Mil �� = c jt/4 p(.:�i_' <br /> CONTRACTOR LICENSE#(REQUIRED): COG-124.5S O22D r (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t.36-7 ei S • <br /> y <br /> PRiMARY CONTACT: ❑OWNER IaCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 75-2-5-2 s')//9 <br /> mit,* 4.+--• CONTACT EMAIL: Mitlidt.a.€65/14la <br /> _ 'f / BUILDING PERMIT APPLICATION <br /> Existing Use of Building: <br /> yo (�'trf` UCe l Contract Price of Work:$ �r04 O <br /> Proposed Use of Building: �N a CItA f Heat Source: (Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi Family#of Units: $1Commercial [Industrial <br /> Type of Project: ❑New :Addition DRemodel ICRepair ❑T.1. ['Sign CDSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:n__ „ae ig „k,_ 5rioa6 C_ id —gep ` 7 X <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .1 ; ,MBCHAPIICAI.PERlVIIT A1®PLICATI®Id PLUMBING SBI MI I'APPLICATION <br /> Type of Project: _New Addn Alteration _Repair • Type of Project: New Addn Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC–Air Handling Units f 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 /> • <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 /> BPRINKLER/BIIPPRBBBION SYSTEM <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 l 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 /> ICPERMIT <br /> � �ll��"�� I 9 .—off <br /> 9— <br /> .6wrter/AuthorizeAgent Signature Date (Revised <br /> 5/ 20 6) 0 <br />