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PERMIT APPLICATIOI^ <br /> � BUILDING/ MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ���� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 J(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `L �ry 0' We,+y,,,0 re_ A 1/e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Steer k- L ter` -o'i TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: V;k:ne C a n td-t^J i.- iD✓t 6,co vD <br /> CONTRACTOR ADDRESS: STREET Q(4o4 We-4-11'49 AvL <br /> CITY tt�1 STATE VA- ZIP Cf.agtt.419 C032-0 <br /> CONTRACTOR PHONE: 20 t-- ('7 g LI k7 0 CONTRACTOR EMAIL: L eke 6` V:)cu C9 <br /> CONTRACTOR LICENSE#(REQUIRED): i /✓C�• V LT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6 (It'?$ (-j'1-2 <br /> LO IT' L 6i,YtSD I/I CONTACT EMAIL: L.,earS �• ' <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work.$' / �l')�• <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New DAddition El Remodel ❑Repair ❑T.I. El Sign ❑Sprintkler ❑Demolition` ❑Change of Use <br /> DESCRIPTION OF WORK <br /> 44. Y'�nv�. 1-1 f s11-1 v4-` e 7 cr0 Yvt 11-c;1�nC e <br /> �X �vc1j <br /> re..1oC-c./12. o v,.q (\ lirV.11Z" r"4 <br /> 4 t t.4% <br /> ASSOCIATED BUILDING PERMIT#(if applicable): s t g ?., -^ 0 0 Co R 210v ` €— re-4-vv-i) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureFixture 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 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 /> 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.lam 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 /> City of Everett Official Use Only <br /> PERMIT#rAVOD \ <br /> 004 <br /> Owner/Authorized Agent Si a Date (Revised 10/10/2018) <br /> qf, -7;:) <br />