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PERMIT APPLICATION <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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /'Z-//c 1 744 /9-{/e..--,"?..--/�j/'2!'G /g201?�� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ,) A_// i. •16/2--(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 677.p.,„,5-e,,,- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET G07 (je.4c4e4C/1 ill/`e'".- <br /> CIITTY"� �(P( (4.14--STATE ZIP ?V 2- <br /> 1 <br /> OWNER PHONE: '6 .4t51-i�s� OWNER EMAIL: e--/0/ D j e / ,,, ` r. * <br /> 2 <br /> CONTRACTOR NAME: „- • d 6,4-1ar 7 x1Ca'�L ti"-e___. f <br /> CONTRACTOR ADDRESS: STREET 5‘7(,pp i '/ 0, A �L j I/1)t <br /> CITY Z}P?fArel ' C� t STATE /ZIP-�y, 0/`F, <br /> CONTRACTOR PHONE: /- ' ` 541 <.< CONTRACTOR EMAIL: (5a/ Z4 d e4Le--iY[ } l <br /> d <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER IKCONTRACTOR 0 OTHER(Please Specify) <br /> CONT `, ;/.4//6._ <br /> CONTACT PHONE: 053' 5.71-5505, <br /> CONTACT EMAIL: q P, 4____e Aa-e,,%f-1-r,j_e<c,,... <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: . / e"`I � Contract Price of Work:$ 3---e=7 ., <br /> Proposed Use of Building: - 1 i Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detach-d ❑SFR-Attached ❑Duplex ulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ,epair DTI. ❑Sign ❑Sprinkler ❑Demm�olilitiioon ❑Change/of Use�,,�,Q <br /> DESCRIPTION OF <br /> ,i rdi2`./' . /eid t- ` cL� 'P W, <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(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 property to perform the work for which application is made, <br /> and I comply •i thae State Conte or • 18.27 W and 296.200A WAC. <br /> P.1, <br /> CityQc <br /> of Everett Official Use Only <br /> T07 7/V • PERI. 0-- O <br /> Owner/• orized Agent Sig :ture Da (Revised 9/23/2016) <br /> / (b <br />