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PERMIT APPLICATION <br /> "PALBUILDING /MECHANICAL/PLUMBING/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 1 www.everettwa.gov/permits <br /> (Blue,or Black Ink Only Please) PROJECT <br /> } SITE INFORMATION <br /> PROJECT SITE ADDRESS: et I ? 5 *S�`ii , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ CONTACT INFORMATION <br /> OWNER NAME: g,.z, �, z A,.3A.,.....- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CIN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Ler,Gid.GZ4- `t <br /> CONTRACTOR ADDRESS: STREET <br /> crw STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 4a.OTHER(Please Specify) i est ° —jr„ <br /> CONTACT NAME: CONTACT PHONE: s y5 <br /> CONTACT EMAIL: 34....00,,,,L0 <br /> 0,,,,aa <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkles+ ❑Demolition ❑Change of Use <br /> DESCRIPTI NOF WORK: q ` xri <br /> C \ <br /> Ait.. .t <br /> Ne <br /> S a \WA-A_ A`o cam_ A•c.-e O <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 t Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler f 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 l Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION 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 am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I compl with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#,••• <br /> RI3I it. l tool-010 <br /> Owner/Authorize Agen Sign ture Date (Revised 5/20/2016) <br />