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I PERMIT APPLICATION III <br /> l4P7SV-_,.--gBUILDIN�) MECHANICAL/ PLUMBING/SIGN I LPRINKLER/ DEMOLITION <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT``SITE INFORMATION <br /> PROJECT SITE ADDRESS: L 3 (,7 2Coce wu 1' 1141 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^Z 5 J cn eGj TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t /,4 294 t,,,..(( (�, (,j/c. to., <br /> CITY Q 0+vt,, ((' STATE (e0 4- ZIP 1. O o i' <br /> OWNER PHONE: 1.06 '-$4/ .. OWNER EMAIL: C h 0i5, To,v 5• (A 3'$4 I ) 51e Fwoc.•.. .� <br /> 'L <br /> CONTRACTOR NAME: C,h 0:5 3© 5 <br /> CONTRACTOR ADDRESS: STREET t ()g, lQ p 4 k (( ter .y it.K. NO 3 <br /> CITY 6 0-Pk.f( STATE W q f ZIP - `-c /7 <br /> CONTRACTOR PHONE: 20 6 —9 Y(-Z , /S CONTRACTOR EMAIL:CV/t,:f , lo„e y, a VN-1/ @ 5 M le F.o.-, ; <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: kOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 20 6 ^ Q 91 1_Lot a.- <br /> - <br /> C \' dn.e s CONTACT EMAIL: Ghc\‘.5 s•. 061 C 5.,CDla.-Vel1Q 5i.k./e11;11/4,4 <br /> BUILDING PERMIT APPLICATION _.--/ <br /> Existing Use of Building:\JI�• Gtrl.' " Contract Price of Work:$_ •tee (4 � ' <br /> Proposed Use of B '•ng: a {- ,CQ- Heat Source: ❑Gas electric ❑Other <br /> Building T •- ■SFR-Detaches ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: LR[Commercial ❑Industrial <br /> Type ,:s 'roj-ct: ❑New ❑Ad.ition ❑Remodel ❑Repair Op. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DE RIPTION OF WORK: <br /> scltf a®4e, . , _ Mu , 1 .,f. �0c.5 <br /> • <br /> A'SOCIATED BUILDING 'ERMIT#(if applicable): <br /> MECHANI • L PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o• • •iect: ew_ 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 I 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comp, ' the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / <br /> CityQaS, OG0 <br /> of Everett Official Use Only (� <br /> h�(`� PER I <br /> •wner/Authorized Agent Signature Date (Revised 9/23/2016) <br />