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Jun 12 2018 12:56PM Washington Watc—aters 8663757454 page <br /> 4errPERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 10E)everattepeaeverettwa.gav r www,overollwa_govlperrnlls <br /> (Blue or Black Ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: /5!5 1�67 �� <br /> PROPERTY TAX#:20‘3600y6-7-71:19 <br /> LEGAL for new construction: Short Plat/subCivision <br /> Lot No. (attach copy of tong legal description) <br /> r <br /> CONTACT INFORMATION <br /> OWNER NAME: &janU a1 <br /> r TENANT NAME(If Commercial); +— <br /> OWNER MAILING ADDRESS: STREET (5145 'Z OA .5'f" <br /> Cfryi7 tri STATE 1 ZIP qp zO g <br /> OWNER PHONE: q .6. --qcr rL' IOWNER EMAiL:: rr VV <br /> CONTRACTOR NAME W*5/4!/JWTfJ Ji'r -el t--1 +Grc� <br /> CONTRACTOR ADDRESS: STREET ]1"715 22,'rt 11£,vet- 74-v( � _ P6 ,Bc x ?2a g ^fir" <br /> cm i"C'e✓I.J CI I STATE tilA ?cid)V 5O <br /> CONTRACTOR PHONE: �.�j— ZIP <br /> � 3- x/71 !CONTRACTOR EMAIL: (.AJ/ 1J/-HV/ (04/11611../ C(jM <br /> CONTRACTOR LICENSE#(REQUIRED): W* t Vii icITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME r CONTACT PHONE: (2. -' <br /> g3-(45'7/ <br /> 1 11-L S CONTACT EMAIL: D / <br /> Lt1�J-GiI/3-ff L i't�.�6 p'L�'tL.(col <br /> JUILDING PERMIT APPLICATION <br /> Existing Use of Building: etalatAkit Contract Price of Work:$' ( U <br /> - <br /> Proposed Use of Building: Heat Source: ❑Gas D ec ri <br /> EI t c ❑Other <br /> Building Type: 'R-Detached DSFR-Attached DDuptex DMuItl-Family4t of Units: DCommerciaf Dlndustrial <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair 07.1. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> VilAtO/Le_ •34-410Le.11- 9'0`-/J-' LAJC64-ji kAth. A <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New, Addn Alteration Repair Type of Project: _ New Addn _Alteration .,Repair <br /> ft of #of #of <br /> Fixtures List of Fixtures list of Fixtures List of Fixtures #of List of Fixtures <br /> 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 tBoiler Lavatory(Wash <br /> i Water Heater rBasin) Floor <br /> Drinkingr Fountain <br /> Refrigeration Shower Floor Drain <br /> Gas Fireplace . Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range <br /> g 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/SUPPRESSION SYSTEM <br /> !Number of Heads I <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 lax. The granting of a permit only authorizes approved work amdno deviations therefrom.Deviations most first be authorized M writing from the <br /> Buikiing Cffieial before being authorized under any circumstance l am the owner.or I am aurhoraed by the owner of this properly to perform the work for which application is merle, <br /> and I COmDJY with the State Contractors w?8,27 RCW nd zed.POOR WAC <br /> City of Everett Offkial Use Only <br /> r/[ Y� PERM Sao_O nerlAuthorizedA ant Sl nature " 1 �" <br /> Agent g Date <br /> (Reels 015/20/2018) <br />