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PERMIT APPLICATION
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<br /> .../s ---',„aii 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: 1,211,c /o 41,,,N sr ,,tre-± 0 fl<D EQ PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: r"'e, ,ti/1 C,n.? TENANT NAME(If Commercial): '',1„,./{oKK Oct-5
<br /> OWNER MAILING ADDRESS: STREET ((,27/�'['� (9/I^ 4v, 55
<br /> CITY EtrNtKff STATE 00 ZIP (-380(‘I
<br /> OWNER PHONE: L/, 3-- .33 EMAIL: t�s',_3 ` -
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<br /> CONTRACTOR NAME: SI-'o, Z(x),,A,v 1-'
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<br /> CONTRACTOR ADDRESS: STREET ( ?t9 y„,,,y,„..0--,7,/� S-�
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<br /> CITY �•J`,/0.,,,,cl nc, STATE V O ZIP .73.3/11/Li
<br /> CONTRACTOR PHONE: ^](7')-- 7..//. (-Cj. -1 CONTRACTOR EMAIL: ..k 6) .41 r`-
<br /> CONTRACTOR LICENSE#(REQUIRED): ell \),'t(\f'..13 9 , . (, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S;,,,5 3
<br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) A (�t6-0 0
<br /> CONTACT NAME: n odt t- CONTACT PHONE:
<br /> CONTACT EMAIL: e)( c:,f'A. ,( (1,, 5c,c ,,,i^p'i't' , e,(_,)4,7
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<br /> BUILDING PERMIT APP •TION
<br /> Existing Use of Building: y Contract Price of Work:
<br /> Proposed Use of Building: Heat o, -. .-: AisprAihmi, -ctric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: MOW r ❑Commercial [Industrial
<br /> Type of Project: ❑New 1❑(Addition ❑Remodel Repair i❑T.I.1e (,)4‹❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: K-q)`"'' ?°`1 C3,4-- cac... pA-cA (,)4‹ ,AQ.S vi, r ‘3i,?
<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 _Adds _Alteration _Repair
<br /> #of
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures
<br /> Fixtures
<br /> NC—Air Handling Units Heat Pump ,2k1 Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater g LI Bathtub Urinal
<br /> Gas Piping Boiler a L{ Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove (2 Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting (a. Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Q. Clothes Washer Medical Gas
<br /> Range Hood fa. Water Heater A Other: Pills 831
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water ' 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.lam 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 1: and 296.200A VyAC.,
<br /> ,440
<br /> /// l3City of Everett Official Use Only
<br /> I PERMIT#
<br /> 400/00,
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