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PERMIT APPLICATION <br /> ���` BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> Imo' CITY OF EVERETT PERMIT SERVICES <br /> IA 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ta _,_ r to ,,._: fied4 CTSITEIN.F,.ORMATL.ON.,._.:.. M:._- ~< .. .: -«_: __ <br /> il <br /> PROJECT SITE ADDRESS:,,+©7 t/r,ev,, ,, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision SV tie 07 Lot No. (attach copy of long legal description) <br /> _.,.S:::. EZSN---,,f, . _.r I .._ ,,'OONTACT INFO NVtitiN , ..:.:.. . ...., .,,, ZI .<...,_, . _ ,_,. ..=-- <br /> OWNER NAME: TENANT NAME(if Commercial): Hot la I u)tui Mar <br /> MAILING ADDRESS: STREET <br /> CM! STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �3 IT Slur `fir v tc.e <br /> CONTRACTOR ADDRESS: STREET ((p 219._ et--hi°k(- -\/7 fell fitoy E2r 3 9 <br /> cnY /! 11 l t (fK vy e STATE A ZIP 9801 <br /> CONTRACTOR PHONE: 14/5 , 3,30, S 1 (p© CONTRACTOR EMAiL: b S(.9r)S@rnsf. Cam <br /> CONTRACTOR LICENSE#(REQUIRED): 4,3T s)sit( cr q p PCS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 5'o 4 <br /> PRIMARY CONTACT: D OWNER 1CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �� CONTACT PHONE: L4 z5.3-50.8160 <br /> PrOnCONTACT EMAIL: bb1,SlCITnSQn1,Sr'. con- <br /> BUH bINGNP.. ITiAPP_UCATION... s_ ..wn....,- _ ....;:.:MsL_ _. h <br /> EMS <br /> Existing Use of Building: CQ inYneract I Contract Price of Work:$ 000 <br /> Proposed Use of Building: 1J( Jit Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached OSFR-Attached 0 Duplex ❑Multi-Family-#of Units: 0Commercial El Industrial <br /> Type of Project El New GAddition DRemodei ORepair CIT.'. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> IIrSir&l I 0)L5ID Stv &SoaG i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> fit' ri#01 N1CAL,PE104.07aPP IC01 N, a "� ' <br /> jl.. �`` "'A- � �`�' ''�=P_LUMBING'PERM1TrAPPL1aTIONIR,'s IShy` <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New Addn Alteration _Repair q <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures • #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures 1 <br /> NC–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal 1 <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain 1 <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 I <br /> Range Hood Water Heater Other: 1 <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> li <br /> SPRINKLER aiti PRESSION'1$:#IEM;- <br /> Number of Heads 1 <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.lam 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 /> 1,11- 1( City ofEverettOfficial Use Only <br /> )2,0 A I ' ® PERMIT; k Li V9 — V `S 1 <br /> Owner/ h iz gent Sign.ture Date (Revised 10/12/2015) <br /> 1 <br />