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I PERMIT APPLICATIOI—moi <br /> 'lip <br /> '" BUILDING 1INECHANICAL/PLUMBING/SIGN ) �INKLER/DEMOLITION <br /> $006, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> IS-3Z <br /> PROJECT SITE ADDRESS: t'-3Z ,eNlcIVlu1 St- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: k 1Q ke.\ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET C 5 Cr 9- { /� 'f <br /> CITY --' -("4"---31ea t_ STATE t/`//T ZIP 9S1 V.j <br /> OWNER PHONE: 425". 3) (• L(c-1 OWNER EMAIL: gip- ken(ee-(4 ,_X5 Z - - <br /> CONTRACTOR NAME: EV1 k 'p, .F .,r..f.� J <br /> CONTRACTOR ADDRESS: STREET (.Z Z C ikj I'kr <br /> CITY .Lilr-sa2 STATE ( '4 ZIP 9to20 <br /> CONTRACTOR PHONE: VI.• —WI, S 7 t /� `�/ CONTRACTOR EMAIL: L. � y...5 ✓r 0 &I(� i�n• ,Co', <br /> CONTRACTOR LICENSE#REQUIRED): \L-ad i °Ok1 5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S5�- <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: fir,k '(}v CONTACT PHONE: 2e.)G,. 11el_ S---?Tr <br /> CONTACT EMAIL: eisIC e enic O 'Pi vw)ier, Cc"+ <br /> BUILDINGINFORMATION <br /> Existing Use of Building: Art--L,11 Contract Price of Work:$],1)dk) <br /> Proposed Use of Building: A-rek Heat Source: IIQGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑puplex ❑ADU `CiMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair CIT.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /) Jk(N5 -7 loess GAP -e."I'tr- (^e°^kr5 <br /> 50 c;(•. 1-41. Vivt r -Wr- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ?Lw g11 —6‘37- <br /> MECHANICAL <br /> 6v2MECHANICAL PERMIT APPLICATION ' PLUMBING PERMIT APPLICATION <br /> FixtureFixrur Fixture Fixture <br /> Count List of Fixtures Co r List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units 2 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) 0....„.. 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> T t City of Everett Official Use Only <br /> ( i <br /> PEl � IW��O1 `"" W2_ <br /> Owner/Authoriz Agent Signature Date (Revised 10/10/2018) <br />