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II PERMIT APPLICAT. <br /> A#111j--"A <br /> BUILDIIUL / MECHANICAL/ PLUMBING /SIM 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 .; <br /> (PROJECT SITE ADDRESS: 2 5 0/ EU wLA# AV-4 ., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> rr''` �^ CONTACT INFORMATION <br /> OWNER NAME:i+c.�..,r1 10.‘.w- ES-O..�Q, :'A:'. .3 �v`�. �c L <br /> OWNER MAILING ADDRESS: STREET c� = Cep <br /> ��r�--ter—�� a <br /> �+ CIN ry-�' yt O(j A 1-- -- STATE (� ZIP �� �OD <br /> OWNER PHONE:�O(0 4 tS S�SI 1................_,..: ..,... OWNER EMAIL: SK0..h "�� '}"`r'we)9 i v.tt. . Liz vh <br /> CONTRACTOR NAME:O l.)v.—t,r' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> ONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT;—0 OWNER D CONTRACTOR iirOTHER(Please Specify) u`k. Ov,�v`V.A/ <br /> CONTACT NAME: CONTACT PHONE: L/ Z 5 _ c%f. �E'— 6 y O 7 <br /> 6" c 1 Fl. Y 3.4' CONTACT EMAIL: jo el go r s R.1 1,44...(41 - ✓+,t. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: c j t 1 \ 'OVA$Q, Contract Price of Work:$ i OOO.— <br /> Proposed Use of Building: CIZ•OON,.A \iI\.o . e. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p Q <br /> vr- a.)c. b C r o o,,✓. W c,S-9.-' IIO C�al 64. S" &(),ot s>r?e, rw. �7�«�� 7/ ' <br /> elk."l 4' 12 -f a 'G_cwr.i- i J il, may. SQaCQ.c2,_.1 fiw iii Ce- l►r4 t A�{-43Lie <br /> . 7`O a k. C.uLaA..i........ __ Q' - _,.. <br /> eiliS J� `` _ <br /> A SO ATED BUIL ING PERMIT#(if applicable): 2.1. - �.++..d� i-o,,;\s O a ft G S)rek A es <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 /> Number 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 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 /> 1 -z 7-0/ock. 001— 0 bi`li <br /> PERMI <br /> \ Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />