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A PERMIT APPLICATION— <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> /111P447#P‘/r/----ACITY 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 /> tElue or Black Ink n1 Please)!=' PROJECT SITE IN `ORMATI N <br /> PROJECT SITE ADDRESS: 4,1101 t l u Gv^ A/C_. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION- <br /> OWNER NAME: <br /> pv o ,` TENANT NAME(If Commercial): rv1.44..S4 ectv C ktJVov.. <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: -Dov. ver C CVO 1 131. 1 Cw"\ <br /> ,� ( 1 -JJ �r <br /> CONTRACTOR NAME: fV Otr rlll ci 'K i/t ve-t'(., eov, ( <br /> CONTRACTOR ADDRESS: STREET PO PI p x I 5-11 <br /> CITY jCAA (I\vtG w STATE y�`� • ZIP !l5Z 3 3 <br /> CONTRACTOR PHONE: 3Le U—�,7 3-(61(0 3 // CONTRACTOR EMAIL: oc<<e torr'i c,.A—wt.?Cvu-hr?,I• CUv". <br /> CONTRACTOR LICENSE# pitli <br /> (REQUIRED). )I p I jC,9 5—L O} CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER Ai CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3CEr —S73.-- C i( <br /> �fu- CONTACT EMAIL: ` A -tr-e,n,cf CUit I . Caves <br /> BUILDING PERMIT'APPLIICATIOIFi,, <br /> Existing Use of Building: 64,S 5-4 74,CA-, Contract Price of Work:$ 16 <br /> Proposed Use of Building: Heat Source: $Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: I2ommercial CI Industrial <br /> Type of Project: El New ❑Addition ❑Remodel I3Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF Wc,, <br /> Ip�Cu,L c 2 n°f l"p Cac.�s tacto lc. tnJ+ ft^ Ise A.) t✓�C.l V_cL. (At V`/ S C t u(A 0 <br /> I-e-v c 7 to <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 I,SUPP1tESSION SYSTEM.' , <br /> Chemical or Water 1 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 /> r—1 PERMIT k,0J b s <br /> ner/Authorized Agent Signature Date (Revised 9/23/2016) /l L„ <br />