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‘51.1!-11,477 Tewob r i 41 PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 O 9 5k- Andre A// A/X if 'OPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot .. j(a ach copy of long legal description) <br /> CONTACT INFOR <br /> OWNER NAME: PG fr?l K 6r e p TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET o'IA 16 45-6-`44((/e 5-4N 4 1 D6 <br /> CITY (it'" at-i e STATE Lt/� ZIP 715?de) _ <br /> OWNER PHONE: 4(a5 - 4/j7- (5100 OWNER EMAIL: ,& c,- cAAe Srtl-rr—r:rs , Gkw" <br /> CONTRACTOR NAME: tviz.6 ride (ie 01,s--1ru G--/r a <br /> CONTRACTOR ADDRESS: STREET /5-7 0 G g fi AAt,U' �a/ <br /> CITY to:A d•t`v eV STATE 44,4/52ZIP 1 8.-/,‘,,,- <br /> CONTRACTOR <br /> /6' "CONTRACTOR PHONE: ,cr6, , p�'"3 . 7/a/ CONTRACTOR EMAIL: (� <br /> CONTRACTOR LICENSE#(REQUIRED): f"'l eAridr r 9 Y.4',T-7... CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)1 1,4 <br /> PRIMARY CONTACT: 0 OWNER V CONTRACTOR 0 OTHER(Please Specify) (0 0 62,1-1 41,(AO <br /> CONTACT NAME: r CONTACT PHONE: 6,26 6 Is/l f 0 <br /> Re.c g�.r J2 r CONTACT EMAIL: rid h 0 G Lt[de G6n5jrcze ide-e...--z <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ S <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: XCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel VRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: {{ �( <br /> 0x6 (..) t( wither `�Y'�s /�Sej `� , /e 'vtio S K/pp61 -Prow, PD T - j p <br /> ipf e t Co e 4 <br /> ASSOCIATED BUILDING PERMIT (ifapplicable): <br /> ea S�(g <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) _(Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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,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.1 am the owner,or 1 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 /> Rier4 -702 0 -I r PERMIT .40,3.....,02,4 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />