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PERMIT APPLICATION <br /> jill°1111 101110/L--4,4 BUILDINCHANICAL/ PLUMBING /SIGN i INKLER/ 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 /> (,B1ue�f Biaci tick Only PteaseOPf;.,...„ ,.£>'ROJE4 A SITE INFORMATION ? .s <br /> PROJECT SITE ADDRESS: ZObO T t,`( S+ � x-lt- VA 18Z-01 PROPERTY TAX#: Z(10517C0 ZO I&O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> b <br /> '""2 ..�>� �. .. �� . , ,, , .. �,� ..��"�y�:....� �01!�1TI��GT��IN>=0 oTtONn 1' ,:a , , ��i <br /> �`� <br /> OWNER NAME: Eveyckv Cpfnrthnvh.ki COI/ TENANT NAME(If Commercial): ??I..{‹...s E-( c-t- <br /> OWNER MAILING ADDRESS: STREET 26lflo To„LI( cSv..(.� <br /> CITY .‘x t STATE VI A ZIP 9 826/ <br /> OWNER PHONE: LI ZS " 3$S - -! WO OWNER EMAIL: <br /> CONTRACTOR NAME: M$ /(V S ANriC , <br /> CONTRACTOR ADDRESS: STREET tcos '3&' Ay{„ S. <br /> CITY •tc.k {_ STATE W ZIP 9 g 11 <br /> CONTRACTOR PHONE: &(p r ?(ea► 3311 CONTRACTOR' EMAIL: C.Wri -1i(AYNC e.i iviiiv,5ty j• ,. <br /> CONTRACTOR LICENSE#(REQUIRED) Ck ctctLiZ \yJ CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): O41Z2(e <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: GO(Jr' Z /till <br /> C1nc'►b\1(,\v\ Ct AD <br /> CONTACT EMAIL: agn4-‘1`03eN t.�1 Mcli:Wytti,tj ea fAn. <br /> 1t, , �A , r . A Oy1L uswiPpayi; ppmTION, e14Ji , �0 <br /> Existing Use of Building: Contract Price of ,or Z.5-00, " _ <br /> Proposed Use of Building: Heat Source: •,.s ❑Electric !ir er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ( kali aerneLifee40 ii4M (3 i* <br /> g� IrrB57S✓O0144 i <br /> eteCowolta,6 Itu p 1 e- weats rh Ylsi,,,,o.s . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 4.- MECI1ANICAL;PER,M T APPI,IGA tiON ,,.':.--,-'- '1-''''11,'''' ':''''':04:011,13.1040' PERMIT1AP"PLICAT1ON i t <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 Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> S°1011:iLE0 I SU;QPRE* 1R`Q61 SYSTE i , <br /> Chemical o(Wats) I 7 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 WAC. <br /> City of Everett Official Use Only <br /> ') <br /> . PERMIT# <br /> 6-' - 17 Kr7o - <br /> Owner <br /> thorized nt Signature Date (Revised 9/23/2016)•- <br />