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PERMIT APPLICATIC <br /> /44, ,..""--, BUILDING 1 MECHANICAL 1 PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> :/--a <br /> 41 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/pernnits <br /> (Blue or Black Ink Only Please) ' PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 59.G. act 14--e 5 PROPERTY TAX#: DOSS 3t3 I co 9.„3 Coe) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: P a Li:a"( C 4 rsoto TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1,r 01.0 C,ct 14- C-5 , <br /> CITY g."V t j C+IF I 'WA- STATE ZIP 7 g LC) / <br /> OWNER PHONE: Li Is- q GI 3- So 0 0 OWNER EMAIL: Day.%) 0 Cqes0A) /4cv tow/ Com <br /> 5 • <br /> CONTRACTOR NAME: p uki Pa c:4‘ c... CPA.1 ste‘'424 ") L L C-• <br /> / o t <br /> CONTRACTOR ADDRESS: STREET 3..5.1 SI s 31-1 /57"e I- ''... <br /> CnY MAAA/5.VAC- STATE kei(4 ZIP 418230 <br /> CONTRACTOR PHONE: LS +G.-Li sA-1---i- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):Nit/J eAC PC VI-S W4- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C)ap 3 Z4 <br /> ,.. <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LI 9,..5- il j3 -S"0 c 0 <br /> D4 Otrd1/4- C 4,5 e P-> CONTACT EMAIL: till'et (g) C a it's,4 / <br /> ,BUILDING PERMIT APPLICATION ,---, <br /> Existing Use of Building: /1.)r /9. Contract Price of Work:$ 3 a, 7 <br /> Proposed Use of Building: --01set, e-, Heat Source: 0Gas I:Electric 00ther Nem e__ <br /> Building Type: I:SFR-Detached I:SFR-Attached ODuplex ElMulti-Family#of Units: OCommercial Olndustrial <br /> Type of Project: 'New 0Addition EIRemodel ORepair DT.I. 0Sign 0Sprinkler I:Demolition 0Change of Use <br /> DESCRIPTION OF WORK: ,I e 6,dVC- ..e I"S'T 0"c C A .c.,e <br /> r <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures 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 /> SIIIRINKILIER/suitioRgssloN SYSTEM , <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.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 /> City of Everett Official Use Only <br /> PERMIT# <br /> 11(32•0/1. <br /> Owner/Authorized Agent Signature Date (Revised 5/0/2016) <br />