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PERMIT APPLICATION <br /> �' � � ` BUILDING ECHANICr4L/ PLUMBING/SIGN I�RIldKLER/ DEMOLITION <br /> CtTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �{E)everetteps@evereriwa.gov� www.everettwa.govlpermits <br /> (Btue or Btack Ink Oniy Ptease) PROJECT 51'i'E II�AFORM�lTION <br /> PROJECl'SRE ADDI2ESS: �j aQ j,�p'��. S (. � �(� PROPERTY TAX#:a$Q��j'��ppaOo�Qp <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach Copy of long legal desCription) <br /> CONTAC'� 91VFORMATIQN <br /> OWNER NAME: LAGC� �� ��„��p� VJ��,p �.�•�. TENANT NAME(if Commerciai): P�(��F�. �{Oi�iE <br /> OWNER MAlLING ADDRESS: srnee-r ��c'�!'v ��. a7'�-S l. S 2J/T� aB <br /> CITY �EfIC�I'Z �JL./'�I�V� STATE LVP'i• ZIP l�O I� <br /> OWNER PHONE: ��,b, yri0 + �� OWNER EMAIL: �(J�j� �pTiNARFALk'�Tl�TL—'.�AM <br /> CONTRACTOR NAME: r�,f�i�l�`,�"�7 ��'.a1 i%•i�l��� �. '�', <br /> CONTRAGTOR ADDRESS: srneEr `7�^'�(G; �� �7� � <br /> CfTY ,+v 1�L�-'�- \S A►-��J STATE '��f��' ZIP L�`�J �� <br /> CONTRACTOR PHONE: �'LS' ��% � " (�,�,� � CONTRAGTOR EMAIL: ��,���;iaL��'��Q����ft� j• C�,�� <br /> CONTRACTOR LICENSE#(REQUIRED): r�� 'S� ` �G� CITY OF EVERETT BU5INESS LlCENSE#(REQllIRE ` <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHOfNE: �6'��� __ -� Q .� (a(����� <br /> 'v' �— , CONTACT EMAIL: , <br /> �� � ��,� �� � �� � - '' <br /> � BUIL.DING PERMI't'�1PPLICA'6'fOia <br /> Existing Use of Buiiding_ ContraCt Price of Wor 5 <br /> Proposed Use of Building: Heat Source: ❑Gas Electric Other <br /> Building Type_ ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I_ ❑Sign ❑Sprinkler ❑Demolition ❑Change af Use <br /> DESCRIPTION OF WORK: <br /> O��;n��,��a� rs� t��:,v.�► �M,�s���,�-tv�.-� +�cr►�.� �r�� _ �9c Q S i r��� S� <br /> it� ,'�1�1� 1�►u�N�F: �f'1'��_. �L�+l� �� �'i.ft'iYi ����c..��r) ��!-�-� �;..t'i'�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable}: N'� "� ' <br /> MECHANICAL PERMIT APPLICA�'ION F�LUMBING PERMIT.+�PPLICI+�7'➢Ot�! <br /> Type of Project_ _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of <br /> Fixtures tist of Fixtures #of Lisi of Fixtures #°f List of Fi�ctures #of <br /> Fixfures Fixfures Fixtures List of Fi�ctures <br /> A/C—Air Handling Units Heat Pump Toilet Sackflow Preventer((nside Bldg) <br /> Forced Air Systems Unit Heater Bathtub urinai <br /> Gas Pip7ng 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 Neater <br /> Exhaust Fan Other:� <br /> Sink(Service/Bar/Mopletc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Neads <br /> .acKNow�pGEnaEnrr.-i na�.a reviewed this app�Ication and confirm tYe information contained herein is true and correct.Work done pursuant to fhis permit must comply with <br /> CUnent fedBfel,stare,efldlOC81l8W.Thg g�2nling Of a pem'�it only authorizes apAroved work and no deviations therefrom.Deviations must frrst be authorized in writing ftom the <br /> Budding Official befor2 being authorized under any circumstance_1 am the ov�.,ec or 1 am authorized by the owner of fhis prvperty to pedorm the work for whiCh oppllCation is made, <br /> and 1 comply�vdh fhe State Confracfors Law 18.27 RCW and 296.20�A WAC. <br /> I ��^ City of EvereH O�cial Use Only <br /> PE IT <br /> � - . s= �� ���7 ��.�5 - �C� <br /> /Authoriz�tl Agent 5ign ture Date (Revised 5/20/2016) <br /> �t' � j�� <br />