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(4;1:4-17 PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /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 I(E)everetteps@everettwa.govI www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: '3 l 2-S ©e^ VS /J-V'e ere*,kAg PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f(c U 4i Hope.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: _ l ' 1 EckQ(16,,/l.,.n-(..,.J cx d ( K 's M ..US) <br /> CONTRACTOR ADDRESS: STREET 773 w'es"- 635A ,co1/4 <br /> cnY 1A)(‘-ry 0114 J t 1�� - STATE kJ/I ZIP 1 e50 7-7 <br /> CONTRACTOR PHONE: t(2 S 14I e1 6q 8 CONTRACTOR EMAIL: `Skno f, ec-ILef ICAme- US <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ,i CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: S rn,hee)..3 CONTACT PHONE: /.42_6 4-6ORg <br /> CONTACT EMAIL: CJ Get e 5 c•-.kom� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> a Waik-- -Tha/t. <br /> ASSOCIATED BUILDING PERMIT#(if a licabl'e): <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:l 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,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with t -State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> d CRloe 11 PERMIT# <br /> F 170 7 —60/- <br /> 0 '"r/Au+orized A. = re Date (Revised 9/23/2016) <br />