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PERMIT APPLICATIO <br /> EVIL®IN ECHANICAL I PLUMBING /SIGN 1 �RII�I:CLPR/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> stay <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: 16 02_ SE t;\Rye* fyi(VI Ijo t,�,t 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No.` (I (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): foot-+ De om r <br /> OWNER MAILING ADDRESS: STREET 22 3"3 L4A-Pa /2 Drive. / VuL 400 <br /> CITY <9)1(1,(1 ra STATE ZIP g G�8 <br /> OWNER PHONE: '401- 9-11 "I tf OWNER EMAIL: '17J►i�(-e Si/2 rz_bi ir-1� �.il&_ -��hor(j ri d,�1 ri .( <br /> CONTRACTOR NAME: n`% O( o J Lt r e,_T(( c- <br /> CONTRACTOR ADDRESS: s Er <br /> d� (dam„ S -- S (..po 2. (n d S <br /> CITY Qayc/ .j"� STATE ZIP e,&Z�g <br /> CONTRACTOR PHONE: (.�•(Jf,c�1,���j1 LCONTRACTOR EMAIL: —. <br /> CONTRACTOR LICENSE#(REQUIRED): ,� <br /> ' L - ,'`AA.- FFCITY OF EVERETT BUSINESS LICENSE#(REQUIR-.): a <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) 11,-9'-'c� <br /> CONTACT NAME: G ,� CONTACT PHONE: a),3 `7 ---(4q---(4q 7 <br /> S-bac'}.Q R a�/e (� CONTACT EMAIL: 5kia_09 sOki 0 CQi't_feY(tO/t7 - s,C� <br /> 1 BUILDING PERMIT APPLICATION O <br /> 0 <br /> Existing Use of Building: ma t $ <br /> )3 7b ° <br /> re_ Contract Price of Work:$ _ ' I �p 0, <br /> Proposed Use of Building: i/d rrP "rim 4- 0-ea1 Heat Source: )2fr.Gas CI Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition (emodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ,Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r F' % w, `A.*. `ir :A ' S <br /> 1// �'' . <br /> IF II - ' s' k.M/19 le\I I I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): YY WNvV ` <br /> MECHANICAL PEMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of _rJ Addn Alteration __Repair Type of Project: _New _Addn <Alteration pair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of L': of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> "1 <br /> 3 I A/C-Air Handling Units Heat Pump Toilet Bac. ow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub L •rinal <br /> 11> Gas Piping Boiler Lavatory(Wash Basin Drinking Fountain <br /> I Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disp.:. rease Trap <br /> Gas Range Ducting Dishwasher e,-- Roo .ins <br /> Clothes Dryer Hookups Other: Clothes A .sher Medical G. <br /> Range HoodW- -r Heater Other: <br /> A Exhaust Fan 16 - ink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> f wci Cherp'ca or W er j? 61Q- 4.s <br /> A�KNOWL EMENT: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 /> PER I # <br /> 11 10 <br /> 0 I \ 611 etz_ i <br /> u Da (Revised 9/23/2016 <br /> Ownei= uthorized A� t Signat r�� � � ) <br />