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U PERMIT APPLICATIOIV <br /> ,I1P-714_ ... BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> IWr <br /> 1 CITY OF EVERETT PERMIT SERVICES <br /> viii <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) PROJE 'SITE INFORMATION <br /> PROJECT SITE ADDRESS: r 7 1.7 I/i w i /#/t PROPERTY TAX#: 43611f h 60 ( a-7_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> d I <br /> OWNER NAME: /,Z 5A f � TENANT BUSINESS NAME(Commercial):/f i - i 0 <br /> OWNER MAILING ADDRESS: STREET PO B /a5-7 , <br /> a <br /> CITY 6.10 STATE W 4 ZIP c7g,90(f) <br /> OWNER PHONE: 00 b -67? 9,5-10 OWNER EMAIL: p k s t•k O(>e. 7 y jj..'e„)„ , <br /> CONTRACTOR NAME <br /> s , ' ' <br /> CONTRACTOR ADDRESS: STREET J { 3 s , ,I. ' L-”Q A p �f 2 #10 7 <br /> CITY � l STATE taA ZIP )(51,,, ! <br /> CONTRACTOR PHONE: 3 g •-3 i). 3 • CONTRACTOR EMAIL: s ..,v�,,�,lltf 7 lits. .►i dr_ ' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):4. '�j^�/IJ <br /> PRIMARY CONTACT: 0 OWNER" <br /> 0 OTHER(Please Specify) <br /> CONTAC NAME:.12-elf_ CONTACT PHONE: 106—_--g3g— ,s.--- 41, <br /> CONTACT EMAIL:ska_voknit,ke oG}��IS l 9....0.1;y1 7 J'YIA <br /> BUILDING INFORMATION ` / <br /> Existing Use of Building: S(�.tc Y�- Y <br /> Contract Price of Work:$ / , 0 O CI, re' <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: Commercial ['Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair fC`T.I. ❑Sign ['Sprinkler ` � Qem.lition ❑ChangeofUj�{ <br /> DESCRIPTION OF WORK1`i�'J( X.1,O y (� l� w,� >` vkitko <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i [p Oe 51 11-1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures cont 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 /> f 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 /> 'Chemical or Water I '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 <br /> made,and I mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT • <br /> 5-" ,tka-rtmo 1g �LC�i510 <br /> Owner/Authoriz d Agent Signature Date (Revised 14/0/2018) <br />