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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> "47111CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 79®o �verytree�, < / PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M ar()C Vac/6rd TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 7900 Evev�rre c�5m y <br /> CITY ve-re - ( STATE S'- ZIP 7Ra t . . <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4_ u4.1 1-4 141 .t3 41c 5�fv <br /> / <br /> ��r / ® <br /> CONTRACTOR ADDRESS: STREET �� 7a �.�e t �Ga, <br /> CITY Silk?",L ; 5 STATE �G' ZIP 78 2 Qo <br /> CONTRACTOR PHONE:0'l6, 7?y ,3t 4, CONTRACTOR EMAIL:d? U(4" I h84- o @ 6 -44 <br /> CONTRACTOR LICENSE#(REQUIRED):AQL)AL g6/ a9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q3--y''6 7 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: _( CONTACT PHONE:0/D '7 get � �6 <br /> Zcf rim{ CONTACT EMAIL: dace jag L fy he cd- (ge, 6 14kaf <br /> BUILDING INFORMATION (( <br /> Existing Use of Building: tear. cJe-Gag( S'*.J Cj Contract Price of Work:$ /.-1( <br /> Proposed Use of Building: C4( 11u.112„r(' Heat Source: VIGas xElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ti Commercial ❑Accessory Structure <br /> Type of Project: ❑New NiAddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4 1d ,y r r Czs c1.cii 4-4-4 vt.i vuT 0-14.1 i — t 14-t—i <br /> 1-4 A-Q._ 9 -f P L) + 6 a \ cb <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING 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, 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/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 /> City of Everett Official Use Only <br /> C 1 ` y PERMIT# <br /> \ v/t.y .....oc,6 <br /> Ow Authorized Agent Signature Date (Revised 10/10/2018) <br />