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PERMIT APPLICATIO+ <br /> BUILDING/ ECHANIC /PLUMBING/SIGN I SPRINKLER/ DEMOLITION <br /> 40j1?-. <br /> I_ Y 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 /> (Blue or Black InktOnly:TPlea( )*Bri <br /> kr1SITE INFORMATIONv , ,F: _. <br /> PROJECT SITE ADDRESS: 2Qi l Li 6L-1-t.,�j`�,. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> u CONTACT INFORMATION, <br /> OWNER NAME: Lj iti,GL l t Noel I '5 {F;,/S.F— l_t_C. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2ci1 (p `j•f,,,402_ . <br /> CITY t\le veil—1 STATE VUA ZIP 61S),10 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'Itivlv) t4 L 14tisp{-i-,.4s ! 1 j1 at• <br /> CONTRACTOR ADDRESS: STREET ' 6 ,t 'cj }{ MT-- <br /> CITY <br /> J t- <br /> CITY nr1 `j V t t 1•t STATE A' ZIP Z ' `G�`�(/J <br /> CONTRACTOR PHONE: 1126 ,z7-ju � 0 CONTRACTOR EMAIL: 61,w •40.- itvikat"[dJ,• �n� ,CC1.1-- <br /> it v- ivbr.2G <br /> CONTRACTOR LICENSE#(REQUIRED): leder t;L. $ ZS 7.atzD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTT NAME: CONTACT PHONE: S iti tivlyi e 6,..,,,,--4,,, <br /> 6 iicad jvie 114 (�( 1 CONTACT EMAIL: Vince z71/l i7VIVt_e 0 lye",<'r <br /> :. .. *-Y '. BUILDING`PERMIT,APPLICATION ; , _ „ .. . <br /> Existing Use of Building: Contract Price of Work:$_�,btx4•°% <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: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): -12..e--P, ei&O'-O 7j <br /> .MECHANICAL PERMIT APPLICATION`S 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 /> 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 J Other:—#- Q. Clothes Washer Medical Gas <br /> Range Hood In elvt Water Heater Other: <br /> Exhaust Fan lroole u 1 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 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 WaW <br /> City of Everett Official Use Only <br /> PERMI <br /> 441'/ .1 i I ,..41 .....ail ifitl n DI- oil 1 ''(-) <br /> •wnj-I ' ture Date (Revised 5/20/2016) <br />