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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN / SPRINKLER / DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> ' ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z PO e2 1 v 1...f�2 5T/'()NV yi, \-j,( \1 PROPERTY TAX#: Z cf O.-/'l Ob 7c>f goo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �11EIT--E,1-1- �n MOVil. j cY/ CO t.i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z 0 t'J t::, I[3t.tJe.2 S <br /> CITY -411 =r. 7 T 4AM STATE ] ZIP 1,,S Ib r Z <br /> OWNER PHONE: 4 �5 , Sb 8 . 9 51 5 OWNER EMAIL: --(—t,�ttl 5 ivi LJ eve re-+tCC._ , P�1.1 <br /> CONTRACTOR NAME: )1: , <br /> E. So L,tq T-1 0 <br /> CONTRACTOR ADDRESS: Z i d O l q t Di Si- ✓t.(f T G 1 7 7- <br /> CITY Li/✓/N Vv t C7t� STATE 1&I Pq 1 ZIP °1 `br�.L 17 <br /> CONTRACTOR PHONE: .c1 r_j- '711 • %,.p; 00 CONTRACTOR EMAIL: &l ayi�e el' °'Sr,(r,r to r vt tiJ ,n <br /> CONTRACTOR LICENSE#(REQUIRED): 1%1,)s 11 Z+p K. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 2 i ---i I <br /> PRIMARY CONTACT: 0 OWNER ja@ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '1 _ Y74. . l03 O o <br /> +c}111_ f--->ciA yr_ CONTACT EMAIL: L ( -� "� <br /> „. �Jt�E' t� M to�'ti'��✓,s-rte <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C.--oi.k E Cr e, A! .t4 r Contract Price of Work:$ '-l--i f'� 9'c '- <br /> Proposed Use of Building: C Di.1.VC, ��M, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 1 emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - , , CA <br /> S�- -,.. .1".1-.1 c� Imo- 1"T e-A.,� __27,)4 <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 YAlteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fiytgres 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 r Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT::l 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, g <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> ,� PERMIT 49 9j -- <br /> � '" � S 7/ 1_C�b� OD S <br /> Ow.. d Agent Si ure gat- (Revised 9/23/2016) <br />