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• <br /> PERMIT APPLICATION <br /> aji,:eir BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits • <br /> "46•cir Black Ink C.nly_Ptease) - • PROJE6T-MTE INFORMATION • - . <br /> PROJECT SITE ADDRESS: 3310 eoo4r PROPERTY TAX#: 00(I tif9e01 <br /> 0 <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> __ . . .CONTACT.INFORMATION . • . . . . •. <br /> OWNER NAME: ',1 /t4irr fie- TENANT NAME(If Commercial): k.f2/ VeA 13!/eop.4n <br /> OWNER MAILING ADDRESS: STREET 33/0 e-"PO if <br /> . <br /> CITY ( Y/�� / STATE code ZIP 9120/� <br /> OWNER PHONE: �/�,� OWNER EMAIL: / <br /> CONTRACTOR NAME:,_ r,.EVeK. 4 L AJ ' 1-4-7-: C "ime A- ,.., .....,.._.. .,.,......_............._.. <br /> CONTRACTOR ADDRESS: STREET 2-112-0 <br /> P 1pt. Auar <br /> p� <br /> CITY t/2- {TY ► STATE ,(,4J 4_ �" n ZIP /2,20/ <br /> CONTRACTOR PHONE: 4s-5-2..52..a3//4 . CONTRACTOR EMAIL: /jlild ç%:�yt 4/l ..eekil <br /> CONTRACTOR LICENSE#(REQUIRED): euer a.SS 02,2 3 T ICTTY OF EVERETT BUSINESS LICENSE#(REQUI—p): &)61 q s-s- <br /> PRIMARY CONTACT: 0 OWNER 1aCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4 CONTACT PHONE: 475' . <br /> 2-5-2---5119 <br /> A- Dr - CONTACT EMAIL: MAtek Les 5rtif <br /> N <br /> _ ' BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,WO elicOUC�� I Contract Price of Wor '. "ir�, a <br /> Proposed Use of Building: Ai D eitR06/� Heat Source: C Gas ❑Electric ❑Other <br /> Building Type: ❑SFR Detached SFR Attached ❑Duplex ❑Multi Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R if n „i Oka- — /„,,,„ no <br /> k(9,,,o,..,...f teemne t/t)5f0eA✓d!r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • <br /> MECHANICAL PERMIT APPLICATION • - PLUMBING PERMITAPPLICATION <br /> Type of Project: _New Addn Alteration .Repair Type of Project: New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems j Unit Heater Bathtub Urinal <br /> j 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/S.UPPRESSION SYSTEM • <br /> Number of Heads __ <br /> ACKNOWLEDGEMENT:l 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.lam the owner,orI 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 /> ®J1 X 7 PERMIT#�„f. ` �c OS( <br /> ll(( i ell <br /> 69vrt2f•/Authorize gent Signature Date (Revised 5/20/2 <br /> C ' <br /> 09fi) <br />