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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • wi 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 07 c/0 5 5,2aibOCI3,4V 6111 / '4^1 BZ0( PROPERTY TAX#: 604/39j J5 '/7 O 3 40 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j (/0 / g'R®/tf)44-1' - V, 1L. C TENANT NAME(If Commercial): /4), - /T 4077.S;47 Ce/J/?/ <br /> OWNER MAILING ADDRESS: STREET /4/8 ivy)/LPL 6= /9'U6-_- 5"0 /� <br /> CITY � /a 45-45--/1' STATE IvZIP '7 e2 921 <br /> OWNER PHONE: a OG Q(/7...z 2 OWNER EMAIL: 0 a,4, ii7e 471'!"0 re Se air/E, corn <br /> CONTRACTOR NAME: /'Y1E7,€t CD/VST/L(/C770At COi/ <br /> CONTRACTOR ADDRESS: STREET / 4/ /92,it-/: 6 66)5'' $U!'TL / <br /> CITY .5 7740/91 /S// STATE (i(/ ziP 96' <br /> CONTRACTOR PHONE: 2 D C 9 4/2 e 2 2 ?'8 CONTRACTOR EMAIL: p{a pa f /Yle7-4a/'e 5e4777e, c d Al <br /> CONTRACTOR LICENSE#(REQUIRED): ME-7 20 C C 23 SOC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):_1705 3 <br /> PRIMARY CONTACT: )1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: o c( 9 4/9 - Z Z r`/'? <br /> IM/Vieg t~/ VCONTACT EMAIL: -4 c <br /> - e�� <br /> c-lQ n � /Y1 a T/'0 re Se a <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /4ET/1/G Contract Price of Work:$ 5',oeo <br /> Proposed Use of Building: R T4/L. Heat Source: ❑Gas XElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> re ry o U€ /YI e 2 en v //r/A i bt2, 1..-=i0 0-1/ ier,N 11, ,..0766 -,o4--- C�2 <br /> TC ,444, Re/we've rf m f //t s7 /l x7-4 /rS ( cc ev <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S G ,Pczr /Yl ir <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 List of Fixtures List of Fixtures #of 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 /> 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.l 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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> . PE MIT# <br /> s — c� - �� G9C%05--an <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />