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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ( 4147.7- (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa.gov I www.everettwa.gov/permits • <br /> (blue or Back Ink Only.Please) . PRQJEC`I`SiTE INFORMATION / . <br /> PROJECT SITE ADDRESS: 362-5'_ (A.C)�,bvl PROPERTY TAX#: Of7Y"55/V12070/3 00 — <br /> LEGAL for new construction: Short Plattsubdivision �/ Lot No. (attach copy of long legal description) <br /> . . .CONTACT INFORMATION . •• . . - - <br /> OWNER NAME: et)(OA L'- I iU(J, drokip TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p,0,150k, 488 nt� Q <br /> cm, E001247T- STATE W A ZIP 1 024945. <br /> OWNER PHONE: taw'` OWNER EMAIL: goya-6 2 wg- it <br /> CONTRACTOR NAME: CUA > AJ `-4-"'TCS �j$fc f/I4gj' -(r <br /> CONTRACTOR ADDRESS: STREET I-12D P 11v, Ac) <br /> isr <br /> Cirr 'C UMETI C- STATE W A-- ZIP 1S20( <br /> CONTRACTOR PHONE: 4'2-5,2-S 2.'31 I q • CONTRACTOR EMAIL: mititag my-4, ,46,4 t <br /> CONTRACTOR LICENSE#(REQUIRED): CO`Y2.64S tato-r' CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED)• C3 6-75'5' <br /> PRIMARY CONTACT: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 475-z5- d-//9 <br /> m CONTACT EMAIL: 1n ia?, A & <br /> BUILDINCa PERMIT APPLICATION <br /> Existing Use of Building: t/ Pi l6f i Contract Price of Work:$ 07NO <br /> Proposed Use of Building: /VD 0446 Heat Source: ❑Gas E' lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel GdRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> K:OR W <br /> F O <br /> 4440 <br /> DESCRIPTION OR .� <br /> R R Gotsh)--- IAez- I 0 kat wl L,,I.,i e,slo t C.oc-► cam <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : ,MECW,ANICAL,PERMIT.APPLICATION PLUMBING PERMIT APPLICATiON <br /> Type of Project: New•_ Addn Alteration )(Repair Type of Project: New ^Addn Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #°f 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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> .SPRINP LER/SUPPCRESSION SYSTEIVII <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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> `�, y / / City of Everett OOfficial Use/Only <br /> `rY 1 3! [ g PERMv ' 1 , %Ok " 023 <br /> OwnerlAuthori gent Signature � Date (Revised 5/20/2016) A.,," <br />