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Mil PERMIT APPLICATION <br /> Ira <br /> BUILDING i Oi ECHANICAL/ PLUMBING /SIGN / uii itINKLER/ DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (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: (1y,J \\ / I!'j' I/('(jam j /,)J\ '/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Loft No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> { <br /> OWNER NAME: �D�I\ � 1 0 r' � � TENANT BUSINESS NAME(Com erciaq: \Eii ..\ <br /> OWNER MAILING ADDRESS: STREET (Onq t -E.lJi rg(re-tao �,j V- j <br /> CITY v C r - ` STATE 1...,...y(2\ i ZIP y' O <br /> OWNER PHONE: OWNER EMAIL: 777 <br /> CONTRACTOR NAME: 4. \ \��.. �f f„.?,1".\/1 \: f .-'' (7, ' Gil <br /> CONTRACTOR ADDRESS: STREET ` r O i / \. 1) I 3 /� A <br /> CITY 4. �iS/nl 7,�,it',,I;1.I � ( /l 1 j �" (' STATE 1t-t t ZIP !� �'j�='11�\ <br /> CONTRACTOR PHONE`'1 3c ) '`1/4-Li 914 V1 CONTRACTOR EMAIL: .___.— <br /> CONTRACTOR LICENSE#(REQUIRED): ,31 \`C 6- ('7) cs] kITY OF EVERETT BUSINESS LICENSE#(REQUI D):SI gL(CZ <br /> PRIMARY CONTACT: 0 OWNER ?CONTRACTOR 0 OTHER(Please Specify) ^-'/: <br /> CONTACT NAME: CONTACT PHON L)a \, 3 LI i---t.--1 o q <br /> j , \1 C'�(� CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: c:QC <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑O r <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> / YISfa(I Ra nd S f.v-N i ) S Co ni p sp t n k; <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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-corn p,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher I Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 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.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /1� .?� /f PERMIT#tel V '� r-1 <br /> � '�� � 'U � Imo. <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) j` <br />