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,_ PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 12 <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.goviperrnits <br /> (Blue or Black Ink Only Please) PROJECT-SITE INFO MAYION" <br /> PROJECT SITE ADDRESS: 3140 3 1,0e5-` I a <br /> PROPERTY TAX#: <br /> LEGAL for new construction. Short Plat/subdivision <br /> Lot No.` (attach copy of long legal description) <br /> CONTACTINFORMATION ' <br /> OWNER NAME: LO„„,„ fQ. MG Ca%C 4C <br /> t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5LE03 f -i t) kieo BA) <br /> /,j <br /> W.,, �d CITY L r t (� <br /> olif STATEiiii <br /> ZIP <br /> COOT OWNER EMAIL: <br /> 2 t 7 <br /> l '1”/ <br /> CONTRACTOR NAME; 1 L <br /> OWNER PHONE: <br /> CONTRACTOR ADDRESS: I4 j `pCc.C:�t�t.,7p�I <br /> STREET ;t}t Vt. 1 <br /> c- `z..-�f+'.e STATE vI .- ZIP Lb'z0 <br /> CONTRACTOR PHONE: L- 2, 10 CI <br /> SO CONTRACTOR EMAIL'o,! ..I 4 `.' 1 AA !.t a"n.di .Co <br /> CONTRACTOR LICENSE-#{FtEUlJlRECi)• . _ �-^^ <br /> ti_ R crffoP'EvERETT BUSINESS LICENSE#(REOUlRED): 1C16:7 9 g <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> Oat <br /> CONTACT NAME: �{� <br /> CONTACT PHONE: 4"26 259 OD <br /> CONTACT EMAIL:6,,, e C Y►'tGL7t cool <br /> ! <br /> BUILDING PERMIE APp�ICl'!t'`r'1G1p * : ` s x.. <br /> ,- <br /> Existing Use of f3uildin : � � ��"" <br /> Contract Price of Work: $ 5 .Cit 63 <br /> Proposed Use of Buildin <br /> Heat Source: Gas CElectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attacheri DDuple x <br /> ❑Multi-Famii 4 or Units: ❑Commercial ❑Industrial <br /> T pe of Project: CNew ❑Addition ❑Remodel <br /> DESCRIPTION OF WORK: ip�tir CT'I• ❑SinISRtinkir ❑Demolition ❑Chart $of Use <br /> lns-tul( j <br /> 09 It) r laces <br /> l�� t d sef( <br /> ASSOCIATED BUILDING PERMIT#(if a I able): <br /> MECMltNIeMI ERIVIIT APPLI "---- IN <br /> Type of Project: New PGPER 'PLICATION <br /> Addnglteratlon Repair <br /> #of Type of Project: New Addn Alteration Repair <br /> #of <br /> — -Prxtnrua- -_._..11�I..oLFdXlutes_ .. _F #of <br /> 1 ures -List.oLF'ixdures----_______ a____xtures _,_ #of <br /> NC Air Handling Units Heal PumpFixfures F(xivras List of - - <br /> Forced Air Systems Toilet Backflow F'reventer(inside Bfdg) <br /> Unit Heater Bathtub <br /> Gas Piping <br /> Urinal <br /> Water Heater Lavatory mash Basin} Drinking Fountain <br /> Refrigeration Shower <br /> Clothes <br /> Wood Stove Floor Drain <br /> GasF <br /> ane Kitchen Sink Cis osal Grease Tram <br /> ClothGas s 0 er Hookups Ductim Dishwasher <br /> e..... Other. Clothes WashOr Roof Drains <br /> Water Heater Medical Gas <br /> Exhaust Fan Other. <br /> Sink(ServrcefBar N1op/etc, Other: <br /> SPIRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water <br /> MI No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein Is(me 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 Offic/al before being authorized under any circumstance.I am the owner,or I am authorized by(he owner of this properly to perform(he work for which application is made, <br /> and!comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0..4,. u v.._ i1 ir, 3. ' Cj PERMITr---�� <br /> Ow.or/Authorized Age Signature <br /> D `-o- -/t <br /> Date (Revised 9123/2016) ""- <br />