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PERIiiiiIT APPLICATION <br /> BUILDING 1 IVIECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I yrww,everetfwa.gov/permits <br /> (DJtie"®r).leek Ink Only.Please) • _PRO JECT`.s0-192 <br /> • k�t INFOR�A`PION - <br /> PROJECT SITE ADDRESS: . 3 O ®vdG� m ►fl l ' PROPERTY TAX II: �(Q®red ���D� <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CON I'ACTt ii�l ®�Nll u ION <br /> elQu r/I-Z . <br /> OWNER NAME: O TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET243 20 eerdi gitt, • <br /> / <br /> CRY <br /> 40))147.1rSTATE kW ZIP ?tap <br /> OWNER PHONE: t( ic- `oIDq.. egg.6............ ....-.,'OWNER EMAIL:...1 D®//V/p f m/e'I4 /'wi v/'" -C . ._ ..:_.,.,... , <br /> CONTRACTOR NAME: C V IdYC.CaMAJ 6 77. T�r CET IA 4,61A-C ...... <br /> CONTRACTOR ADDRESS: STREET 942.-0 PA-CA F AU <br /> CITY SV STATE �(�. - ZIP 6/ <br /> CONTRACTOR PHONE: 4 -5-2.c 2..-P. /IL • 'CONTRACTOR EMAiL: Niro i Z l&C f,65 mrvA • • <br /> CONTRACTOR LICENSE#(REQUIRED): V t jS c>2,�0 r (CITY OF EVERETT BUSINESS LICENSE#(REQUIRE. Ca es/el s-s- <br /> PRIMARY CONTACT: 0 OWNER J ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 7 S--25-2-'5/f <br /> d a CONTACT EMAIL: <br /> ' • BUILDING PERMViiTAPPLICATI®N • ' •_ - • • - • <br /> Existing Use of Building: t eill4V616 I Contract Price of Work:$ EV 0 <br /> Proposed Use of Building: NO f%' 66 Heat Source: Ideas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CISFR-Attached ❑Duplex ❑Multi-Famify4 of Units: gxCommercial Olndustrial <br /> Type of Project: ONew ❑Addition DRemodel CRepair ❑TI. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ij _ 15 _m ) kit) Ups bAwA.,-R4,0 /so • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' .•MYIECIHAilICAL PERMIT APPLICATION I . • . Punvi6iltle PERMIT APPLICATION <br /> Type of Project: New^ Addn Alteration g Repair , , Type of Project: New Addn Alteration •_Repair i <br /> of List of Fixtures I Ttre°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixus Fixtures Fixtures <br /> AIC—Air Handling Units t 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 /> ' '. . .- .1Fi.I IlPCILIE 1 ,V-PPIII.EPWii,1 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.I am the owner,or!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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> ��O� � ^ <br /> Owner/�z . gent Signature Date (Revised 5/20/2016) /v <br /> 41117, <br />