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PERMIT APPLICATION <br /> 04-7TBUILDING I MECHANICAL I PLUMBING 1 SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 I(E)everettepsf&everettwa gov I www everettwa.gov/permits <br /> (Blue or`Blatck Ink:Only Please) `PROJECT;: 1TEgOiFO tiVf:0ft3hl s,g',' ` '-r-,4:.: <br /> PROJECT SITE ADDRESS: 2-301 t WS- PROPERTY TAX ft: <br /> LEGAL for new construction: Short Plat/subdivision ---.1--------- Ldt No.� (attach copy of long legal description) <br /> CONTAG'tt;1$FORMA`1`ION` <br /> OWNER NAME: �1 JJ 5 o v-re l.j TENANT NAME(If Commercial). <br /> OWNER MAILING ADDRESS: STREET �jy'^ �v/JL4a OA 0 C3 <br /> ''j `�.,+,r� <br /> CITY STATE ` (✓i #. <br /> _ jj zc� <br /> ,OWNER PHONE: 92N-5--- <br /> i jQ j /a OWNER EMAIL: <br /> CONTRACTOR NAME: 4. l riIn C — <br /> CONTRACTOR ADDRESS: STREET 14 Ity oc u ,t.� t <br /> •este.. `" 0 <br /> CITY STATE (�ZIP CF V� <br /> CONTRACTOR PHONE: L- <br /> q i 0 CONTRACTOR EMAIL•.' Jo I ii 11" .14 ! el n/ •co g <br /> ---- CQNTGE <br /> RACTOR LINSE4(RCC UIRED):- �..09C.-�Q 4----CITY-OF-@VERE'T`T-BUS1N 3-1 CENSE#(REQUIRED) -1 c}t,q-(g- _ <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z� �. rJ- ZS ? y0 SD <br /> L CONTACT EMAIL:600,10 a °�`r rte t 'co nei <br /> : BUIL.DING}'Potivilfi'P,Ariki 1'(Ghir hz9Tox 'f ` <br /> Existing Use of Building: Contract Price of Work:$ _ <br /> Proposed Use oFildlng; Heat Source: ❑Gas lectric DOther <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex DMuitf-Family-#of Units: DCommercial Dlndustrial <br /> Type of Project: ❑New OAddltion ORemodel ORepair DT,I, DSign DSprinkier ❑Demolition DChanrde of Use <br /> DESCRIPTION OF WORK: <br /> ( h-$ A1-LLS 66rIPIA-1111r <br /> ASSOCIATED BUILDING PERMIT It(If applicable): <br /> MECHANICACillEttMET APPLICATION s ; ;,-e "_mall G .ER ii 'li ti PlidATI,t N <br /> Type of Project: New Addn Alteration Repair <br /> #of — Type of Project: New Addn _Alteration _Repair <br /> If&LtlfEllcttuas #of #of <br /> _Fixtures_ — Fixtures ._List-otRixfu es-- #of <br /> Fixtures — rel-a�fxfufies- Lief of Fixtures <br /> NC -Fixtures <br /> -Air Handling Units Heat Pump es <br /> Forced Air Systems Toilet Backflow Preventer(Inside Bldg) <br /> Unit Heater Bathtub <br /> Gas Piping pnifer Urinal <br /> Water Heater RLavatory(Wash Basin) Drinking Fountain <br /> e rigeration "Shower <br /> Gas Fireplace Noott Stave Floor Drain <br /> Gas Ran a Kitchen Sink&Disposal Grease Trap <br /> f3ucti Dishwasher <br /> Clo hes D er Hookups LDther: Roof Drains <br /> j3.22221-ood Clothes Washer <br /> r Medical Gas <br /> Exhaust Fan Water Heater Other. <br /> Sink(Service/Bar/Mop/ate.) ,Other: <br /> SPRINKI-EB I SUPPREuSION,SY&TEM ' '.' <br /> Chemical or Water 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,stale,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 Oficial before being authorized under any circumstance.1 am the owner,ori em authorized by the owner of this properly to perform the work for which apptica(/on is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /� City of Everett Official Use Carib. <br /> ►4.4 <br /> '3 — I c.-. <br /> 1PER \ OS <br /> Ow-sr/Authorized Age Signature <br /> ;1 v �C[�I/��xv <br /> 9 Signature Dale <br /> ' (Revised 8123/2016) <br />