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/0414,ye_—___A. <br /> PERMIT APPLICATIO= <br /> "IP' {UILDIi L MECHANICAL/ PLUM z!NG /SIGN /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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Bine or Black Ink Only Please_) '-OJECT SITE INF-if RM, TION <br /> PROJECT SITE ADDRESS:5 ns 5E. Ever a/ 0 P O E Y TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. lii(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:DO� N y1I 1 ISkSt CASK TENANT NAME(If Commercial): LSI,.' ..tck lad(iy,q <br /> OWNER MAILING ADDRESS: STREET \t/�...�. ��� i\�� A .& 802. •J <br /> cITY Y�r.N. `oao ��V STATED l� ZIP 47a D1 <br /> OWNER PHONE: { V- OWNER EMAIL: <br /> CONTRACTOR NAME: CYO ) i-iV.e.. p, . t r I 1 Yr.,_. <br /> CONTRACTOR ADDRESS: STREET pep %Op( \2,A\�j <br /> CITY 111‘1\ �' WPC- g STATE ZIP f i <br /> CONTRACTOR PHONE: L. Z.S.4s,r1(alc—! 'CONTRACTOR EMAIL: :yeSS\COACrova _ t ► ` \' <br /> CONTRACTOR LICENSE#(REQUIRED): '��(�1�L.�LL,.... CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0.3)517 <br /> C� <br /> PRIMARY CONTACT: 0 OWNER AGONTRACTOR 0 OTHER(Please Specify) �y <br /> CONTACT NAME: CONTACT PHONE: /./2CJ.L 'E1-1at/) <br /> � <br /> CY ie8Nie.. �, CONTACT EMAIL: C lr iS l a.Gy i `Ylt•et2 r)....., <br /> BUILDING PERMIT APPLICATION <br /> v <br /> Existing Use of Building: Contract Price of Work:$ �6-00. <br /> of <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑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 kprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,L -1/4, 22- h eo43 <br /> f.M. <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 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.I am 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 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> C ? � <br /> /2rf? POb <br /> wne/Aut orize Agent Signature D (Revised 9/23 2016) <br />