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ri <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> /1111°%//----"A 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) ;ak, .=PROJECT SITE.INFORMATION _:' >; - <br /> PROJECT SITE ADDRESS: 331( /"tGD�Ju( &I( AA, • PROPERTY TAX#:0043gO7160ZV 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION • <br /> OWNER NAME: g,, r�/r;,G��Q7 TENANT NAME(If Commercial): <br /> r Alt/Otrlt3>? Ak?...DkslAfL.E. <br /> OWNER MAILING ADDRESS: STREET FC) <br /> O. 4jQ S 451 <br /> CITY v" wet 96201 STATE ZIP <br /> OWNER PHONE: 42s-- 954 — 0900 !OWNER EMAIL: <br /> CONTRACTOR NAME: N'aw( tC-0 -rQt cr ryt,.‘ <br /> CONTRACTOR ADDRESS: STREET ;366 C1WSTh"T s-rfebr <br /> CITY EVEE T1" STATE w f- ZIP '�/T2ZO <br /> CONTRACTOR PHONE: 42.S1 <br /> S—2S —1111 CONTRACTOR EMAIL: ((ll <br /> CONTRACTOR LICENSE#(REQUIRED): K1,E\CILALA- gig L.6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 'OTHER(Please Specify) A RLH 1-1V-C'r <br /> CONTACTNAME: <br /> ,Mt,GS Wct*'6-� �� CONTACT PHONE: zs 0E408 <br /> TVY<<r <br /> 1\1 k-\ �' l ALL / OOF-t,H/Wr.5 CONTACT EMAIL: wl1'(es ,t tI7V11�tGtr GGt•(GfiYt <br /> BUILDING:PERMIT APPLICATION . . <br /> Existing Use of Building: Al/A- Contract Price of Work:$ OW/000 <br /> Proposed Use of Building: WAep-fa)S Heat Source: 'Gas 0 Electric 0 Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ErCommercial 0 Industrial <br /> Type of Project:,IINew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: New 1O,oOo5r viAri.E44 0 u5EMo SAk. �.Q. / 5 co <br /> M FEZ ks I , ONE- office Mt, A ROO M 1100 T co .SM . Lel• v <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERMITAPPLICATION 1 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 /> A/C—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 /> • <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/SUPPRESSION SYSTEM <br /> Chemical 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 /> (l,Dit/20/.7 PES\qog -OI 9 <br /> Owrr/Authorized Ag nt ignatu e ate (Revised 9/23/2016) <br /> C 'h) <br />