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PERMIT APPLICATION <br /> 0 111. BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> . CITY OF EVERETT PERMIT SERVICES <br /> � ti <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 2..2.. C ro,a?r\,-Dr` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (=,eor;dna'r, � A- TENANT NAME(If Commercial): /1!`A- <br /> OWNER MAILING ADDRESS: STREET 322 tea,,,,A` .�r <br /> CITY Eft 7J STATE 60g- ZIP 02,a3 <br /> OWNER PHONE: 425- SD/—f'7 / OWNER EMAIL: Y je,— 6y i,•-1 ygh0e, eiptti. <br /> CONTRACTOR NAME: Sm f/1L�iDtiS --/-ed G Le- " {rim 4-,-/I-Az�d <br /> CONTRACTOR ADDRESS: STREET 4,7 2 6dgle ii4 y/ I 3`/ <br /> CITY 6:27orn4 STATE w4 ZIP 9",/ <br /> CONTRACTOR PHONE: g2....s-- 24e1_55"4,-2.... CONTRACTOR EMAIL: 54la4 019&A9'/, , / Lail <br /> CONTRACTOR LICENSE#(REQUIRED): SOI.,,tart_9O 3 3-R. CITY OF EVERETT IOW- <br /> LICENSE#(REQUIRE q•` OIL( <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) i' " bib?. 03O I DQ I <br /> CONTACT NAME: Er l4_ 4.,,,,,t4)/j CONTACT PHONE: Lf Zs.---24.1.-S✓C&,-Z.- <br /> CONTACT <br /> ZCONTACT EMAIL: gbt pdryte„,y9 - i s1ar�,rPP <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ReAide.....0.41a4 Contract Price of Work: '._ 4®110 <br /> Proposed Use of Building: 54,kne, Heat Source: ❑Gas ❑Electric %Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: i Commercial ❑Industrial <br /> Type of Project: New ;Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler •:- olition ❑Change of Use <br /> n <br /> DESCRIPTION OF WORK: op 42-1/X / tQ/` X!2 rivo-r Go yer, Ota Aar <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 Toilet Backflow Preventer(Insi.= Bldg) <br /> Forced Air Systems Unit Heat- Bathtub Urinal <br /> Gas Piping Boil- Lavatory(Wash Basin) Drinki • •untain <br /> Water Heater -frigeration Shower - .or Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookup Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> (Exhaust Fan Sink(Se -/Bar/Mop/etc.) Other: <br /> SPRI ER/SUPPRESSION SYSTEM <br /> • emical or Water I 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 /> g�[ ,5/314,0PRT.(g� `co.. <br /> Owner/Authorized Agent Signature /Dateb (Revised 9/23/2016) <br />