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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN /SPRINKLER"I DEMOLITION <br /> Id--A <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 i 26- (c (Lj y /1-1/4„ PROPERTY TAX#: Oct 4 39 '( Z 3 7O (ZL O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> p .CONTACT INFORMATION /J <br /> OWNER NAME: #i' &, I' <br /> rsfi <br /> I Z' Cj'wv t o t gvtV4- TENANT NAME(If Commercial):CotLIYap+1,- 0,cly <br /> OWNER MAILING ADDRESS: STREET 5Z 9/2u c(cep Ave S4-, /00 <br /> CITY C Lit-C 0.CA STATE Of/4- ZIP ?a2-0 I <br /> OWNER PHONE: ,'ff t3 e ma/rots-1- r OWNER EMAIL: e Co tR sT 44 % Co3'Yl <br /> CONTRACTOR NAME: I�►ovt�i L T-cwt�L¢vr1 cv 6,' ( 7-vt C. <br /> CONTRACTOR ADDRESS: STREET >p p.)G /5"-q L� <br /> CITY � v l tk 'vv' STATE to f ZIP t Z 3 3 <br /> CONTRACTOR PHONE: 3(,o- Y 7"3 _cL+(D 3 CONTRACTOR EMAIL: :lake_ i t o✓J i t..te vu p coo:11,0i'• CG wl <br /> CONTRACTOR LICENSE#(REQUIRED): /VDK OzTc 935--GA- 1604 1*i% <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ,®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> t Ul CONTACT PHONE: 3 - &73- E,& 3 <br /> TTS CONTACT EMAIL: Jakec@ i t o rd 1‘4---be Pr7/0 C 0.-71-1/b%, CC-14-1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Wontract Price of Work:$ �3 <br /> Proposed Use of Building: Heat Source: CBGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel giRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 9910- s \Ale} <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 Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> ' . NC—Air Handling Units 2 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 2.- Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> j-Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER SUPPRESSION SYSTEM,.;., <br /> 1Chemical 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 /> �� /7 PERMIT#�1 (v—(u <br /> 'Authorized Agent Signature Date (Revised 9/23/2016) <br />