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PERMIT APPLICATION <br /> "IIIP'44. <br /> BUILDING /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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S�Z Z L 0/r'1 QAge, A-a PROPERTY TAX#:Od 4 317?-5-46 21 tib <br /> LEGAL for new construction: Short Plat/subdivision C`-./ 7ZEir DI,/ "A Lot No.2/12Z(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: mot-6- l 4 5T, �i=Q KLA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3S-2Z 1-441Af3A.et A-Viti- <br /> ciTy Vela STATE 10,4 ZIP 9 S 2e 1 <br /> OWNER PHONE: / 503 57-7 42 3 OWNER EMAIL: k-5PItek--5 ill$ -&4.1 -IL s ccbs-A <br /> CONTRACTOR NAME: p.„4„..-,rte. &SAG-63 /,L- <br /> CONTRACTOR ADDRESS: STREET i 31 i Pc›1( z.>4 6 6,44-14- . <br /> CITY 1—t)Lit L-)1 STATE (/Li/1 ZIPq J 2-71 <br /> CONTRACTOR PHONE: 40-5— S-09 147S2 CONTRACTOR EMAIL: Eb•61.Sc,P-1 N PALAFyc.(a 'A 4,4:5-Cr.S.4 <br /> CONTRACTOR LICENSE#(REQUIRED)::?,kt.�t-r6.1 DS't J>t) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER {'J CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /I7_." i5 4.7S'Z , <br /> C)t-SUs CONTACT EMAIL: /� <br /> g,D,i2L,S0ti1 e T,4. .)Fr<6A44C G S,(O/c <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4'O,COO`'' <br /> Proposed Use of Bu" ing: ?AJ A66 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: L'ISSF�FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: 27 ew addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , 67.2 r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): pc. 0-073q8'3 <br /> MECHANICAL PERMIT APPLICATION PLUMBII+�:G PERII 1T 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 Other: Clothes Washer Medical Gas <br /> Range Hood / Water Heater Other: <br /> Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical 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 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# <br /> ��'�i� ( (O(( -- 603 <br /> Owner/Authorize Agent Signature Date (Revised 9/23/2016) 1—? <br /> e <br />