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iiii PERMIT APPLICATIIII <br /> BUILDII` MECHANICAL! PLUMBING !SIG'SPRINKLER/ DEMOLITION <br /> E V E R E T TCITY 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 orz:Black Ink E my Please),:;.. PROJECT;BIt:tINFORMATION,.,� . .,...» ,_z. ..#.._ .. <br /> PROJECT SITE ADDRESS: qa b PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> , A NPORM,010NI. <br /> �O T 'CTy kW <br /> OWNER NAME: &o,l 6(.4( e7 SCA ;1-in TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 9 I 3 J �'-- <br /> s <br /> CITY yi/ STATE ZIP <br /> OWNER PHONE: 112S ZS2. '7/:?1 [OWNER EMAIL: <br /> CONTRACTOR NAME: 4-145 d- JT14G <br /> CONTRACTOR ADDRESS: STREET Po Rf)'`K 1 12.... I /J /�j G <br /> CITY r r ! Cir Vi r//t STATE/�/4 ZIP O 270 <br /> ,/ Dom- r <br /> CONTRACTOR PHONE: /�2. S S 60 2.0 / CONTRACTOR EMAIL: ' eAdiSe!'+l/CeS_ ob--pi <br /> CONTRACTOR LICENSE#(REQUIRED): /IL,���IA 94 12' CITY OF EVERETT Bl7SINESS LICENSE#(REQUIRED)• S''' ZL <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:7" CONTACT PHONE: qt( ...?6. 2 7 SS/ <br /> 1 0 147 LaI i1/1'e ' CONTACT EMAIL: H / (r 4&, (ervk es e oy,t,i <br /> . -::. . ;'. ,.E . . EU ..DING.. 1.101RMA. O . <br /> IL TION <br /> Existing Use of Building: ,5"-f2 Contract Price of Work:$ /IS-000 <br /> Proposed Use of Building: Heat Source: ❑Gas ,'Electric ❑Other <br /> BUILDING USE: FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New DAddition 0 Remodel . -epair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTIO F WORK: <br /> ro 042 <br /> Wiiii0 SlieGht4, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> l.. MEEHAN OAL;PERMIT APPLIGATIQN<.. KONiglI40 PEIt 'IFAPP'L10:01:0411 .,,. .: . ;`: <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-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 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 I SSUPPRESSION 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 I comply with the State Contractor. aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Owner/Au ho e d Agent Signature Dat (Revised 4/15/2019) <br />