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ORIGINS. PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> "liPi•Y--g 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 /> -- _ rA- PREC SI NPOMTION . _ F <br /> ; , <br /> PROJECT SITE ADDRESS:1N6 rd / , PROPERTY TAX#:QO3/13( 003/I ' i"( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attachcopy of long legal description) <br /> iA, 1rr CONTACT INFORRMATION, i r,�u."_ ,; ,n. A I; ,.._ -, <br /> OWNER NAME: VINV tO` W,P,)h TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0'5—tie lam goi <br /> �j 8/1 CITY lEVIre/ �STQATfE((A hi �/� ZIP'? 2�� 5 <br /> OWNER PHONE: I-,2 - t0 OWNER EMAIL: Paw. .W em Iah2o cow) <br /> ' <br /> CONTRACTOR NAME: 1()L. F tame, <br /> CONTRACTOR ADDRESS: STREET 1 t1 C3 i7� (� St ) <br /> CITY Haunt II L' T t STATE ZIP 6160 <br /> CONTRACTOR PHONE: 'I2 T-1 --1 •~ CONTRACTOR EMAIL: Info 1 C I nti/ I i , , r <br /> CONTRACTOR LICENSE#(REQUIRED) L' /f F ftPj-61/G , CITY OF EVERETT BUSINESS LICENSE#(REOUIRED). 5 z7q <br /> PRIMARY CONTACT: 0 OWNER ACONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L` 5-- —fl 1 ----15G <br /> ann3, ea 1 # CONTACT EMAIL: 1 iiilA' 'pv lvef 11/ ifArdIAA w <br /> ` r��liu��.. A-i �.�.�� ffgt2SZR= ' BUILDING PEIR APPLICATIOR ui ti." rM'is IiETSI%gi�,�i,�o�`"� <br /> Existing Use of Building: Contract Price of Work:$ 1-5-7 n <br /> Proposed Use of Building: Heat Source: ❑Gas Avlectric ❑Other <br /> Building Type: NSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New 'Addition ❑Remodel ❑Repair DTI. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Yljeai pump jisialiorhon <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> w4:1 ECHANICAL"PERIVIITAPPLICATION 5 4a , ,, PLUMBING PERMIT APPLICATION;_ E,;; <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units 1 Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> l 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 /> aSP, I LERI;SUPPRES,SION��8WOM�it��� ,..' . <br /> Number 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 ;tate i,ontractors La 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> d <br /> v16,70 PERMIT# ' rl �-0� 4 <br /> O ner �1 -- T'• .y�1>.i•.- re / Date (Revised 10/12/2015) XV <br />