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41ETT PERMIT APPLICATION <br /> BUILDING ECHANICAL / PLUMBING / SIGN / RINKLER / 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: &I ZO y ��F Aver (Flake-�) PROPERTY TAX#: 2 'Oh(I o 02 b O C <br /> LEGAL for new construction: Short Plat/subdivision Del., # I 0 Lot No. _ (attach copy of long legal description) /"t,pp 0 <br /> CONTACT INFORMATION <br /> OWNER NAME: P.luau. GcrjO • TENANT NAME(If Commercial): H(dit-FI'te �ye .„) <br /> OWNER MAILING ADDRESS: STREET PO L °W'1 0 <br /> �� / C�p'h <br /> CITY �[�yvv V•W L STATE wA ZIP !/Oru -g <br /> OWNER PHONE: �ZS • `H4, • 53qt f/ OWNER EMAIL: 2t4 f U-e t t�,t,(t{ r(.�1�/i( C.'f-K�Llifee✓) <br /> CONTRACTOR NAME: Mao- / <br /> gta,('14fuli. Lselle t <br /> 'L'vT �,JJ <br /> CONTRACTOR ADDRESS: STREET U Gwes)-la.lc,� Ali_ ( f'o g oz c(R fib) <br /> CITY ca, e STATE WA ,Ip q r!(Jq <br /> CONTRACTOR PHONE: ttj(/ •6 t 2 t 7-4-7-0 CONTRACTOR EMAIL: �j n a 6e[(e • CD n t ----•CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESSJLICENSE#(REQUIR ): 0 0 S 69 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: Ma.* Q CONTACT PHONE: G , G$2,4*7 0 <br /> Q CONTACT EMAIL:ma: . CLp t .item , eb 44 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 0g et- Contract Price of Work: $ 1 2.5� 000 <br /> Proposed Use of Building: D 4ha Heat Source: ❑Gas DElectric ❑Other P/A-- <br /> Building Type: ❑SFR-Detached ❑SFFR-Attached ❑Duplex ❑Multi-Family-#of Units: ) Commercial ❑Industrial <br /> Type of Project: ❑New DAddition R7 Remodel ❑Repair kk.I. 0 Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: y t.Zito r .441.44.014i,K o4 ey.tS4 i• L M S/ <br /> de- ug-irst-( ve S far a ih <br /> e�dtits I iotAbtu� with/, iw -utC c1-00 t5 tat- 1-t +ts avt- vt , �trrv'de <br /> uJ .Cs uft�t � V�Dt �e-rrutrre -Fl�c h i fwu[se. Waitau-ePeign '&kvezt t. 54 pot, will k est.17 ctA acivr daered Ga 44./.6.,. suio ti <br /> � . <br /> ASS IATED BUILDING <br /> PERMIT# if <br /> ( 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 /> INC-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 SUPPRESSION SYSTEM <br /> Number 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 /> lly; <br /> PERMIT#'6� 1 (001, <br /> oce) <br /> t <br /> n S e d tpf b,iol,(� Jl01 <br /> Owner/Authorized t Signature Date (Revised 5/20/2016) <br />