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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> rF _si- 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 1 www.everettwa.gov/permits <br /> (Efluie.or iSfack Ink Only Nlease) • : • PR®MCT-iit I131QOjaMATION - - <br /> PROJECT SITE ADDRESS: u1 3 7 /UAir€6,4dD-.) &4If 'PROPERTY TAX#: ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> -- ---------- <br /> ---- ----- - -- ---- <br /> COfa1TACT I�IOb01IAISI®IV • <br /> OWNER NAME: C O,� 011,46 %,UJTENANT NAME(If Commercial): FAA A- ✓f45 <br /> OWNER MAILING ADDRESS: STREET 11/f9 ( l f IDI �t W /6 e... • <br /> CITY I�J /t.' 1j(/jc),4 STATE '�1 / ZIP if czi/. <br /> OWNER PHONE: ��ea�i us/�0�414/1/ //9.- .- OWNER EMAIL: A c I e ,` 11,,,5 CP 1549‘,� ems, <br /> CONTRACTOR NAME:-. ..E...•..!'�YC.C�'-- vA r..,..,...•6'Tarn( <br /> a Tn(..n_• <br /> G?te-{ ptRsFA-c-...,..- <br /> CONTRACTOR ADDRESS: U STREET �I -0 PA-CA AU G <br /> • <br /> CITY 0 VW-MTSTATE tiv4- ZIP /4320/ <br /> CONTRACTOR PHONE: 4-2.-5-,2_c 2-'''' t/4 • CONTRACTOR EMAIL: /u440 @ e59A4T ( <br /> CONTRACTOR LICENSE#(REQUIRED): EUG12.6.js c o r [CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C..)(3-7 j • <br /> PRIMARY CONTACT: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A CONTACT PHONE: 475-2-5-2-'>/19 <br /> f"tpg1J .- CONTACT EMAIL: frt.Adk <br /> &c >VIA4A <br /> .' • • . ' . 13(11[DIW(a PEISItfIIT APPLICATION• • • • - <br /> Existing Use of Building: j"-lW Pp Price $ 0,�,® <br /> Proposed Use of Building: IvaHeat Source: XiGas ❑Electric ❑Other <br /> Building Type: ❑SFR Detached CISFR Attached ❑Duplex ❑MulContractti Family#of Units:ofWork: <br /> 5tCommercial ❑Industrial <br /> Type of Project: ❑New ClAddition ❑Remodel [Repair ❑T.I. ❑Sign CDSprinkfer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WO K: / �q y-{ '6416 ��( JS 5 <br /> R4 Ifel Lill ci - �j,uc ..mSvc) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 11 <br /> .: ' .M CU,ANICAL.,PER MIT-APPLICAT ION 1 I , PU(1I1(I6114O P kIYllT. ,PPLICATIOM <br /> Type of Project: New Arkin 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 /> A/C—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 /> ' .. : .•SEi INI(LE 1 S,IJ,PPRESSION SYSTt'IEM ' ' ' <br /> Number 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.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> C —.X2(57(-->2 .__ItA, <br /> 6( VO r PERMIT#:im \ofy^L r � <br /> G+FPierfAuthOrized Agent Signature Date (Revised 5/20/2016) J02-b. <br />