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PERMIT APPLICATIOM� <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> AlOf,� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I IZI V1/4) MAle)0C.- \I t C''") 'De- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION t <br /> OWNER NAME: Awa}Ai S. Tjs,I,�-41..o'r- TENANT NAME(If Commercial):PN}s-t-N lO1.S4'Si- u.nA <br /> OWNER MAILING ADDRESS: STREET 170 . --M os e <br /> CITY, t� ,` !IA:E STATE VST` zip cis©Qp <br /> r <br /> OWNER PHONE: 7,6"J '� '` 01'.3. -2"-- `OWNER EMAIL: Ae-Ate, p c� fl /�i L .CO 1 <br /> CONTRACTOR NAME: •Ftet-t '\20o"V AJIll CC, Ill•-1 j <br /> CONTRACTOR ADDRESS: STREET -2... .51`24 <br /> T /( <br /> xT-04. M.� S Q� <br /> CITY <br /> �F" , STATE UJ 4 ZIP 9(JV 3 Z <br /> '.2.-- 17".CONTRACTOR PHONE: Si-4-17/4F /CONTRACTOR EMAIL: t <br /> CONTRACTOR LICENSE#(REQUIRED): -e��L.-DO-5 2-6,t0 2-L 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):'b,"f 2' <br /> PRIMARY CONTACT: 0 OWNER V CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '26-72 -'-pct-7., ,e(4,7C" of i 1 CONTACT EMAIL: ` p e�"I e,t dS yoo-cseiv I C&,c0 r <br /> BUILDING PERMIT APPLICATION I <br /> Existing Use of Building: 4--Akka- 1T Contract Price of Work:$______ 11-1 Q", <br /> r6J 6 23 <br /> Proposed Use of Building: 1TA'u1N Heat Source: ❑Gas ❑Electric, ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: L7 Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -pP 0 J E (1( io©S ,r.(o ) S�,�'t L� <br /> 10s�MA-' �, C.0wt\o“ i-kloiik PI PG) L5.-5 <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 #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 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 ( 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 /> PERMIT# <br /> Owner/ prized Agen Signa r Date (Revised 9/23/2016) <br />