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PERMIT APPLICATION
<br /> ILI
<br /> BUILDING I VkCHANICAL/ PLUMBING/SIGN / UkIRINKLER/ 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> Glue or;8#acli Ink,Q tly`Please)..•;. PROJECT SITE 1HF,ORMA1 IO#,, .i , ., g .,S.. , ._ j •:.
<br /> PROJECT SITE ADDRESS: 1/).2 O hoy`fi f\�- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision // Lot No. (attach copy of long legal description)
<br /> 1 . , ,
<br /> COMTAi�'>I'ItSI�ORM:4"I•Mf�R . :� .
<br /> OWNER NAME: A (1, TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: �-Jy-,Ps(,„a,,,` 9, L2 0('Ca. IIF_
<br /> CONTRACTOR ADDRESS: STREET tog ,A(..e,/`,snA t(UQ
<br /> CITY g(f STATE (c)A ZIP 9',307,0,'
<br /> CONTRACTOR PHONE: 7( q��e�02`j CONTRACTOR EMAIL: d--i c yv4 g�c?f L1a�7,c�,r 1
<br /> CONTRACTOR LICENSEI#(REQUIRED): S E N 'p, ` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:( C 4'10-.geja.g
<br /> CONTACT EMAIL
<br /> c-04-&-t, �t 4Oi r(Cly lI(/t l arc,efiv ...c,04�f�ai G
<br /> l` ,.SOILDtNC INPOitM 4 "!ON M!41:Nt.., ,., . `,.
<br /> Existing Use of Building: y_ Contract Price of Work:$ 02, SSim( � � am.
<br /> Proposed Use of Building: Heat Source: OGas lUElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Immercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: c-q(eic,J2-'Aso-eti Ct,0 o C( o d-te,,. +6 6,..):(J .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION,, , , .. PLU.MS1N ,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 /> 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 )I 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 SUPPRE_ SSION SYSTEM, .•,,.l 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 bein•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 wi = e C,ntracto Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> IF PERMIT#() R.c)(0_
<br /> do \
<br /> Owner oriz=• Agent Signature Date (Revised 4/15/2019)
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