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s t.1/0—e-C-Xte-Qa41T1 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN I SPRINKLER I 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 ZciiC)c'KCY:Dia-k0025:r0C- <br /> PROJECT SITE ADDRESS: /3//C) .932‘7447424;417 PROPERTY TAX#: <br /> LEGAL ferl)ew-construction:-Short Plat/subdivision NR3, Pe4f -L-eit-titrr" (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: WO-1 Tv.e e.....A. c) TENANT NAME(If Commercial): wed9 Ve r <br /> OWNER MAILING ADDRESS: STREET 3cci c...,...0 tot4C-i f- fed 04 5 33t: / <br /> , , , <br /> CITY Vle,e., 4-I.e...44) STATE t. L- zip 64e,if 5 <br /> OWNER PHONE: OWNER EMAIL: <br /> / <br /> CONTRACTOR NAME: S/1)9 '- 1--f-, <br /> Ti-e-4 66a,6: ie_CONTRACTOR ADDRESS: STREET 5-7/ 34e, 1(, l 4, 014 V,' ‘..".* 10 7 <br /> CITY riz--t. STATE (1(41, ZIP Cf e)1.4 VI <br /> CONTRACTOR PHONE: Z S7-5-4,ZZ- 2..I 4 Co CONTRACTOR EMAIL: rec.-1,1 :05flyi 4ech.e.ey,.4. - • a ., <br /> CONTRACTOR LICENSE#(REQUIRED): ‘C-i N Tl 1-1i o ...3' CITY OF EVERETT BUSINESS LICENSE d(REOUI 0). 5 <br /> PRIMARY CONTACT: 0 OWNER lir CONTRACTOR 0 OTHER(Please Specify) (01. <br /> CONT47 NAME: / CONTACT PHONE: 2 s—z, c /I_ 7...4 4 4) <br /> K <br /> /,,," /c„,.. i CONTACT EMAIL: lat._ &3 xivi <br /> , <br /> / BUILDING PERMIT APPLICATION <br /> Existing Use of Building: .4.,7/- Contract Price of Work:$ 4-f, q 00 -- <br /> Proposed Use of Building: SA-VA..kHeat Source: °Gas 0Electric DOther <br /> Building Type: OSFR-Detached DSFR-Attached °Duplex °Multi-Family*of Units: °Commercial °Industrial <br /> Type of Project: ONew ClAd ition ORemodel °Repair DTI, IESign °Sprinkler 0Dernoiition OChange of Use <br /> DESCRIPTION OF WORK: ... '4. :' kata-( CfCte.f., 5.,€4-5 . (0 5),,„ t <br /> .-D <br /> ASSOCIATED BUILDING PERMIT#(if aplicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION iT-7.-)2-121 <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of U of if of #of <br /> List of Fixtures List of Fixtures List of Fixtures 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 /> ......— <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„pireumstance.1 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 with the State Contractors).aw 18 27 t4Cti4/and 296 2004 WAC. <br /> _ <br /> i I 1 11 4°U1A "7 PER TN, <br /> iSCity of Everett Official Use Only <br /> n.( —OO <br /> Owner/Autho zed Agent Signature ate (Revised 9/23/2016) <br /> 1 : ,,..... ) ,.....,.., <br /> .. . ....._..............._............................................ . ........._.............._____ .. <br />