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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> #111PATI:s4CITY OF EVERETT PERMIT SERVICES <br /> vagi 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 INFARMATION <br /> PROJECT SITE ADDRESS: 430 5tA) Cafe(4 M4 11 Witt PROPERTY TAX#: 00 51492 O00000-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> :, ., CONTAer INFORMATION,. ' <br /> OWNER NAME: 5+e c'kGtan(, ) Fb rik di 5 LI-C TENANT NAME(If Commercial): En-l'tv?2f,`Se ren+rA-Gott" <br /> OWNER MAILING ADDRESS: STREET I 2.Pic vtoGe. crrtr 421, <br /> CITY I` 0 V--; -E'eo �JJ__ STATE WA 1 ZIP 7$9276- <br /> OWNER <br /> $9076- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: CFM I'k Ct4if5 a.nl CooIin5 <br /> CONTRACTOR ADDRESS: STREET P 0. 130)( 3205 j <br /> CITY K; (�1a STATE L,t„A ZIP 96O(� 3 <br /> CONTRACTOR PHONE: 1125-(37-i- 1213 CONTRACTOR EMAIL:)eft?my@ C FM--NVACR-CO IA <br /> CONTRACTOR LICENSE#(REQUIRED): 0 FM E HCS 61 C iP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Mot-tie{ CONTACT PHONE: 925- 36y -52.06 <br /> 0-eie,mi CONTACT EMAIL: j- cMy@ CF1-f}tocg.erDM <br /> ' BU:1LDING'PERIVIIT,APPLICATION <br /> ,, OD <br /> Existing Use of Building: Co M et-c U 1 Contract Price of WorA I 110D. <br /> Proposed Use of Building: (,p max(cia 1 Heat Source: j_Gas DiElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repaair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of <br /> Use <br /> DESCRIPTION OF WORK: Trlt"W.\ 1 ttuJ „i ' fl 6-ietrY1 I/1,f&-' eI)97 CU'CI I ratio ("0- (Nee er• <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 111e1)-01 <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 IHeat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems i Unit Heater Bathtub Urinal <br /> f 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 1 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.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 /> PERM( 0+, <br /> %i� GL -/7-l7 <br /> Owner uthor' a Agent Signature Date (Revised 9/23/2016) <br />