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PERMIT APPLICATIOI <br /> #11141014,'"---A <br /> 1114' BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> , CITY OF EVERETT PERMIT SERVICES <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:5/® &A/air (-5 ,,,0 L \ 6 PROPERTY TAX#: (9$o yi3 0,4_0)5-Do <br /> x <br /> LEGAL for new construction: Short Plat/subdivision Lot No. ).- (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .04-.) .S II <br /> 1- <br /> C TENANT NAME(If Commercial): 7..c. �S Fc e4 C-14. c/�,v,. <br /> OWNER MAILING ADDRESS: STREET c).4(i-j /7 G tb- 5.,- N 4 <br /> CITY Ncvvy Vj l((� / ,STATE � - ZIP qz�..7/ <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: Atre„t f-- %A. <br /> CONTRACTOR ADDRESS: STREET 6---4- 13 191 4...,, 5 <br /> CIN Cj--4AT--- STATE IA(kf ZIP q5(c& <br /> CONTRACTOR PHONE: 406--'3 i ,B0). 7 CONTRACTOR EMAIL: /L-1--(0 G iee,,,,/f rj(,/4/I '' Q_GUIM <br /> CONTRACTOR LICENSE#(REQUIRED): f!Z�� 5 C-rp 5- , . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR KOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 0106 ...,t, _ Nig <br /> K( ' 1 i, CONTACT EMAIL: k lam-9yer fi tifrt cog.c,y/l <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ct.,vl/ Contract Price of Work:$ a3jodb <br /> Proposed Use of Building: 5. ,or G„ - Heat Source: RGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: fommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , // at r �J' t �- - ,A S�!`"J /'_ ,. <br /> G/i AA Mit U ,4e r .L J-1 �"' <br /> 1a 1 I <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 /> NC-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 /> fRange Hood Water Heater Other: <br /> I 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 OfficialUse Only <br /> is <br /> 87/' r PER 1#toot...0 0 --- <br /> ner/Au orized Agenignature ate (Revised 9/23/2016) 0. <br />