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i'lii*"7"7- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN / 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 `(E)evereltepa a�everettwa,gov 1 www.eyerettwa.gov/permits <br /> (Blue or Black Ink Only Please) ^ `I R©JECTf <br /> �(TI:��=I1��'C1tt!`Vllll'1'`It�N' *_°,:''''.e"':1-' <br /> PROJECT SITE ADDRESS: 2,C/0 .r t5t S <br /> w' PROPERTY TAX#: <br /> LEGAL for new construction: Short Piatisubdivision <br /> Lot No.' (attach copy of long legal description) <br /> CONTACT-INFORMA"t'' QN <br /> OWNER NAME: } f1 <br /> TENANT NAME(It Commercial): <br /> OWNER MAILING ADDRESS: STREET 2`" Qg 2 <br /> ( /y +�+ cj vill er ' q n ,ilk <br /> 142 2 32 _... STATE �/(f ZIP ,� 20 <br /> OWNER PHONE: „� , `44 � OWNER EMAIL: <br /> CONTRACTOR NAME: D +t� tri C. <br /> CONTRACTOR ADDRESS: (� <br /> STREET + �/' •�"'}}-t^r ocktiw °ti s y <br /> CITY 4.-�r+�,L.i �^'1.w'V�...4-/t k»t-\«,l[7 <br /> STATE 1,x.1 ZIP L U .f...:o 1 <br /> CONTRACTOR PHONE: l 23cr. 0 <br /> so CONTRACTOR EMAIL• t tt 11 A, t A—Ina .co <br /> PRIMARY <br /> CONTRACTOR-LICENSE <br /> AGT *mi''R-LICENSE#(REQUI <br /> TRfiED): .. _CICl G'� <br /> _CITY-OF EVERETT BUSINESS LICENSE#(REQUIRED) 1066 9 se <br /> (D� <br /> CONTACT: ❑OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L,. ,2S 25t3 as/ <br /> 'Debt u2- <br /> CONTACT EMAIL:do ,1.,a e 1 ke( <br /> t, co ni <br /> Existing Use of Building, <br /> Contract Price of Work:S srx". <br /> Proposed Use of Building: <br /> Heat Source: Xas ❑Electric ❑Other <br /> Building Type: XSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I, OSign ❑Sorinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: Rept <br /> as —,,cu, ritQcC.._-• <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERMIT APPLICATION <br /> Type of Project: Naw Addn ' '1'l:K,1MBING'PERMI'Y`��!PLt+CA�'tGIN <br /> AlterationRepair Type of Project: New <br /> #of 1 Addn Alteration Repair <br /> #of #of <br /> - ._....#_ofafxfares_ -_.L _olF�xlxttts FlzZtresLsa-of xtures— - dxtttres _ TLtstsfclxtNxe <br /> ---....•.E,sfofFixtures <br /> Fixtures <br /> A1C—Air t Iandling units Heat Putn <br /> ___Fnrced Air SySfert7s p Toilet Backflow Provender(Inside Bldg) <br /> Unit Heater Bathtub <br /> Gas Piping Boner Urinal <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Gas Fireplace Refrigeration Shower <br /> Wr�od stove Drain <br /> Gas Ran.e Kitchen Sink&Die.osal Grease Trap <br /> Clothes D er Hookups Ducting Dishwasher <br /> Other: f Drains <br /> hmnge 19csc Clothes MedicalWasher Gas <br /> Exhaust Iran Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER'/SUPPRESSION SYSTEM <br /> Chemical 0,--'77'r"'''---"'—•—•—'•—•,7-5-1=—.. <br /> ACKNOWLEDGEMENT.•/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 <br /> rk <br /> Building Official before being authorized under any circumstance.I am the owner,or amoauthorized by/the ations owneer of this property to perform theDeviations must firstework forZwhiin ch application is n ade, <br /> and I comply With the State Contractors Law 78.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Alt..... ` g <br /> � f � <br /> O.,eriAuthoriaod Age ,65.____D <br /> Ci Y7 <br /> 9 Signature Date <br /> fRevi>sarr 9/2312076) <br />