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PERMIT APPLICATION <br /> el*,. .,...., ,. ,:vo, <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> " CITY OF EVERETT PERMIT SERVICES <br /> ; 0. 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 /> .. .. :< .. PROJECT SITE:INFORiMt'TION,,. <br /> �QR /• 3 PROPERTY TAX#: 0057.2.2 o2.id 0,240 <br /> PRQJE��S�EA fT(J�� �t� S{+� ,��'G <br /> LEGAL for new construe ion: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> g,.. _ CONTACT I NFORMMAT OJ <br /> OWNER NAME: r' ]�� � � �-' i <br /> 7 fl BLecid,(1G.TENANT NAME Of Commercial): �/Ul!'& rl�tyt 4, ,i t. Y <br /> OWNER MAILING ADDRESS: sTREET42 5 /�LGaive s-k A- Q i <br /> CITY <br /> i I�yrt It <br /> _ J STATE ith ZIP qQ 2,e <br /> OWNER PHONE: 4/2.5—...33/.—...q..;;;;-1/(....... OWNER EMAIL: <br /> ...'{,./Q0J ,..... F L'wmd� 1 nei <br /> CONTRACTOR NAME: r iJA AA ) e- ,.ry/k.e$) 41..0 <br /> / p/G(C <br /> CONTRACTOR ADDRESS: sraeeT �'` /�Slde <br /> city S/10 hernish STATE 14IA ZIP 6) 01�D <br /> CONTRACTOR PHONE: .1/ - _w i�//'-��A-38', CONTRACTOR EMAIL: GT li e a �vvic4rT, /lel <br /> CONTRACTOR LICENSE#(REQUIRED): LP0 h 2S 1/3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5D "6-- I <br /> PRIMARY CONTACT: 0 OWNER Ii2rONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4,2S'r 30 F., Z <br /> i/'j7 / )j✓l� CONTACT EMAIL: �G O r!1 y�� `� �5¢ E� <br /> BUIL DJINIG PERMIT APP!L1CApp:p., <br /> Existing Use of Building: iliai? Q Q�rjC G Contract Price of Work:$ li OD 0 Oc) <br /> Proposed Use of Building: dexhte /g c_e_112/nedia.,!-J(QvYL Heat Source: P'Gas DElectric DOther <br /> Building Type: @SFR-Detached @SFR-Attached @Duplex DMulti-Family-#of Units: Erommercial Dlndustrial <br /> Type of Project: @New DAddition IH'12 model @Repair DT.I. OSign DSprinkler @Demolition change of Use <br /> DESCR PTI N OF WORK: <br /> - -4l a 612 Wark Me% -1-zi iY1t%i 6i2Iee/e i4m4 rd d fls <br /> -torn 4h1O-C Suile) dy. c..rea.kn9 eetni yawns 4v,n o sp-tO ah6y- S ufs <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> gMECHAUiCALtpERMIT APt LIC/ATIODt PLUMBIIr9G,.PERMIT APPLI.CATi®iN , <br /> Type of Project: New_ Addn _Alteration _Repair Type of Project: _New _Adds Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 ' 5 Lavatory(Wash Eiasin) 1 _ Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove _ Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting r— Dishwasher _ Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer — i Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan —��Sink(Service/Bar/Mop/etc.) Other: <br /> :PRINKILER I.;SUPPif ESSiON SYSTEM. <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.I em the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT/%111[1.4 --- I __Vki.- 3 % //.3 <br /> Owner/Authorized Agent Signature Date (Revised 90 /12/2015) <br />