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PERMIT APPLICATION <br /> eirp 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 I FAX 425-257-8857 (E)everetteps@everettwa.gov i www.everettwa.gov/permits . <br /> (blue®r Black Ink Only_PIease) . PRS.!JEGT S*TL IMI;ORMATION • • • • <br /> PROJECT SITE ADDRESS: (It 6c EU 6-turt ( WA✓I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . ..CONTACT iNFORMATION . •. . . - ' <br /> OWNER NAME: 613 'E;!L• a1(1W TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ll, e71 6' o • <br /> CITY E/"tviIri 4 STATE u144 ZIP L 024 <br /> OWNER PHONE. ` t96 ti.......6(4) 2... . IC', �� OWNER EMAIL:,,. IA Goy n 4t,.4, N1,-t L......,row( <br /> . 7 , <br /> CONTRACTOR NAME: E t1CK.�11'-• AJ 6ra`1,o: $-Ec j/L1,6111rC- <br /> CONTRACTOR ADDRESS: STREET 2-I Cil Au gr <br /> • <br /> p� <br /> CITY 'FY✓V e - STATE WA- ZIP ei s2O( <br /> CONTRACTOR PHONE: 425.12•S"2.obi Kt • CONTRACTOR EMAIL: /o"ii(,t 0.,f, otacck A... <br /> CONTRACTOR LICENSE#(REQUIRED): COG-1'24:5S..,.,.I" Cll Y OF EVERETT BUSINESS LICENSE#(REQUIRED): 4.)co el 55 <br /> PRIMARY CONTACT: ❑OWNER I I.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 75-2S2 s,//9 <br /> • <br /> •Nth- 041 kle <br /> CONTACT EMAIL: MA .`-' 55/4' 47 ,et,` <br /> • ' .ii v RUILDiNG PERMIT APPLICATION . <br /> Existing Use of Building: a 4j 4t,if,,- I Contract Price of Work:$_41_,_,000 <br /> Proposed Use of Building: Heat Source: ❑Gas ZElectric ❑Other <br /> Building Type: ❑SFR-Detached [ SFR-Attached ❑Duplex ❑Multi-Family#of Units: 121.Commercial ❑Industrial <br /> Type of Project: ❑New DAddition NiRemodel ❑Repair all. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: . <br /> A0`)i N t -2. k-1u6 ,,, S PeAAAPD v A it> ) 1-0 6C.3 c lc"' but <br /> 124ptvet 4S.e D (lira wt// - Aezewp%54..0 b y ,40Di A.16 e02.5.2445PA'5. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IVIECNANICAL 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 /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 v Grease Trap <br /> Gas Range ?1._ 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/OUPPRa”IO9 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,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> tTh.-00-- <br /> 114(TiO —D-7 if <br /> 43verterfAuthoriz gent Signature Date (Revised 5/20/2016) <br /> t <br />