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11
<br /> @LD
<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION
<br /> �.1111
<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: if;frS' f C 4,e SL if v t,re-ft" Jam► b),1 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: f`I,K,kii/t ,,,.? TENANT NAME(If Commercial): S,I,r„riov, I-lf, •5
<br /> OWNER MAILING ADDRESS: STREET (,7//i' /9) 4, ')r
<br /> CITY 1';1/' ir'fi- STATE C ZIP -/A O4
<br /> A � i
<br /> OWNER PHONE: 1-1/.;,),s-- 7 ^ 59 .>.--,3 OWNER EMAIL: ` • I ` ,..-14-,
<br /> CONTRACTOR NAME: 5(li..:. �(), k� e f'
<br /> CONTRACTOR ADDRESS: STREET J 3 V(\ ;.(--c,r, S4-
<br /> CITY A /7t ✓t ci n STATE Vfte4 ZIP L 3 1Ill
<br /> CONTRACTOR PHONE: 7(7 5 I- /p j-03 41.9 CONTRACTOR EMAIL: $(.rar -t' r (�, , ),,.(- c:,-)1,11
<br /> „
<br /> CONTRACTOR UCENSE#(REQUIRED): S 6 \),.t e,t 3 94; SC, CITY OF EVERETT BUSINESSILICENSE#(REQUIRED): ,5-;;),5,3 6
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: kit i --Itt r CONTACT PHONE: 70g_ )cr^'.1- i(/? LI/
<br /> CONTACT EMAIL: 5( 4.I..•re-e 5GaC ',.t /..--z;-2'' ,,•..,41
<br /> BUILDING PERMIT APPLICATION :,
<br /> Existing Use of Building: Contract Price of Work:$ 1I075/( .D{,-)
<br /> Proposed Use of Building: Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ( () ❑Commercial ❑Industrial
<br /> Type of Project: [New DAddition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ■Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: K�(3
<br /> t Gr e ?vt C3s-'+- C4C. 1 (-”bt �f` 1 ifir
<br /> - , �t J1Q•5 !n1 At` eY
<br /> 1
<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 #of
<br /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures
<br /> NC-Air Handling Units Heat Pump �, j Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater a L.f Bathtub Urinal
<br /> Gas Piping Boiler Q LI Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting ( Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas
<br /> Range Hood t Water Heater J. Other: I4se g;b
<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.I am the owner,or tam authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the ate Contra . , 18.27 RCW aryl 296.2000A WAC.
<br /> / / ��I �C an? hV � PERMIT# City of Everett Official Use Only
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