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FAINI <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL 1 PLUMBING 1 SIGN 1 SPRINKLER/DEMOLITION <br /> 'Mai <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.gov I www.everettwa.gov/permits . <br /> (Blue or Black Inks Onhi..Please) - PROJECT SITE INFORMATION " <br /> i <br /> PROJECT SITE ADDRESS: See>2- 6 t )PROPERTY TAX#: eV q I 1300 ?e2(9&o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • . - _ .. . ..CONTACT.INFORMATION . .^. • . . . . <br /> OWNER NAME: 5S.5;t1f. L-� TENANT NAME(If Commercial): GetkeS t s Lk.) <br /> OWNER MAILING ADDRESS: STREET 25 3 2. (3(f'T 5( s E <br /> c1TY E-A)K41-t- STATE 'a ZIP q e ZDg <br /> OWNER PHONE: &06` G 3/- DU 2 OWNER EMAIL: 54211-/L-1- ep.c..,e�/ G <br /> CONTRACTOR NAME: EUCCa AJ 6rarrer `�J �. WAG -c. <br /> CONTRACTOR ADDRESS: STREET °-127 Ci-t pt. AcC) <br /> 61. • <br /> my 'F:✓V STATE (Lf - ZIP (i S20/ <br /> CONTRACTOR PHONE: 4 2- 2-o23r Iq • CONTRACTOR EMAIL: /4/4ee C55 A- <br /> CONTRACTOR LT` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C]6-7 el 5.5- • <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:n CONTACT PHONE: 4'7�j e 2-5.2 d`�l/9 <br /> - j//,oy,t__ CONTACT EMAIL: 111414.. Co SSiviwA •C°" <br /> • BUILDING PERMIT APPLICATION <br /> • <br /> Existing Use of Building: b G6 I Contract Price of Work:$ / JG <br /> Proposed Use of Building: 1J U CS Heat Source: ❑Gas LElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi Family#of Units: [$Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel 11•Repair On ❑Sign ❑Sprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: I t �( / <br /> f)Aa_ £xt5Tivb q -C(,Z`� I-((P w 1 E(1C i~a uit,tT. u7)bl27 - <br /> E'T'�2 row IANz f cw (69 Say, T-,d/r'%4-Lo2t-title r 4/ ( SkB16ito J sp",00,Lr S I/.J7 Eei, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .MECIHANICAL•PERMIT APPLICATION . PLUMBING PERMIT APPLICATION • 1 <br /> Type of Project: _New Addn _Alteration hRepair Type of Project: ^New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units I 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 /> • <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> • <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> '• : .'SPRItnCLER/ .1.10FiRESSI®0 SySTEMUM ' <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 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PM <br /> AQ 7_ 1 I.,, a %Cq. -04 5 <br /> Owner/Authoriz gent Signature Date (Revised 5/20/2016) <br />