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<br /> ,I°PPERMIT APPLICATION
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<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
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<br /> PROJECT SITE ADDRESS: /,024,c / / 4 p Si CVe�-tt (fin 384PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: (•i,Y ai/t (1,,,;in TENANT NAME(If Commercial): ,i„r,IU( , (-�r,�-
<br /> OWNER MAILING ADDRESS: STREET ((,?i// - /rj 144 4,ff $g /�
<br /> CITY V"Q fr'f�- STATE l�)YI ZIP �,, „er�`>.
<br /> OWNER PHONE: W j'' ' / ^ ,j 3-3 OWNER EMAIL: ' ,i r 1
<br /> _� � �����t'`�...r` ri) cz,-”0a i f of. ; U�'l
<br /> CONTRACTOR NAME; SCA_ -(y A,9 r
<br /> CONTRACTOR ADDRESS: STREET ( J 9 ye„. 3nr-k-;,,n �J�t"T x
<br /> CIT' 1 ! t /W A Ii nG STATE k/ ZIP j,3,i 1 t
<br /> CONTRACTOR PHONE: 7(7 j L.14,f-( ✓ CONTRACTOR EMAIL: $(.,.11--t,' r , 5C,5 0).A. c, ��>scri
<br /> CONTRACTOR LICENSE#(REQUIRED): Q�`),,11 1'1 c:-._6 4 (� CITY OF EVERETT BUSINESS UCENS #(REQUIRED): _5-2,5,3 6
<br /> PRIMARY CONTACT: ❑OWNER K.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ! jytf-- CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> n BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: /1?'1'` ca.r,,iI Contract Price of Work:$ 4{(pl,j(,b
<br /> Proposed Use of Building: ,nly/Li 'C"'""vsv 17 Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: /Z. ❑Commercial [Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> hep'c:cc- c�` No:�- 1tAC iJ c\aL Wr-1-4..s v5 U) Ir' 90(
<br /> ll
<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
<br /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump f Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater f 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 /„2 Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: i A Clothes Washer Medical Gas
<br /> Range Hood la Water Heater o2 Other: /. g'L,
<br /> e
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water l 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 lam authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the S.e Contractors :.27 RCW and 296.200A WAC.
<br /> I/ J2171/3
<br /> City of Everett Official Use Only
<br /> � PERMIT#
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<br /> �i-a/ $O F-D 2—,
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