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j�op <br /> PERMIT APPLICATI• II <br /> ULDII�1 MECHANICAL/ PLUMBING /SIO`:I ---•RINKLER/ DEMOLITION <br /> __. CITY OF EVERETT PERMIT SERVICES <br /> viiii <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 slack Ink Only Please) P •JECT SITE INFORMATI*N <br /> PROJECT SITE ADDRESS: S i ©t{ F(e y,; c, Si'. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) <br /> CONTACT INFO'?MATIOi' <br /> OWNER NAME: Zd1P-t 7,e H s-,-- t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 51 0'1 f)crv'v.q S. , q <br /> CITY F: t2•r'e. J STATE Lp p! ZIP 1 0 2 0 3 <br /> OWNER PHONE: 4-125•- 6$'2..- 6 I I OWNER EMAIL: 1..v„i c, 4tv,:t er.( [i"e,C.00-i <br /> CONTRACTOR NAME: pewrot,1, (t- HcA-f"<<+Jh it- Lod(i v,a1 Zvt,, <br /> CONTRACTOR ADDRESS: STREET 3crc /1111 /O r• JS C$ p C <br /> CITY Le ke_ � r_if.. /5 STATE (A A ZIP L T2- Dc <br /> CONTRACTOR PHONE:'j25'-•33 4—t1(Do CONTRACTOR EMAIL:46.E tk(F,r...t. Vleh4.,• 1 a..,..L coo 11.7 i i,c.�o r+ <br /> CONTRACTOR LICENSE#(REQUIRED):Argo( al(D KIS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (ps--33q-SI o 0 <br /> Gineck G m v a fl 1,1 CONTACT EMAIL 14y,ksp4 r,dlk 1.jeh.-.,t;...) lit.*<0..I,'v3i hc,cc-en <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5-F A Contract Price of Work:$ .7-C1;7'U <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> \ /^ <br /> -- u Y�n., -2 -t• 65i VI E.vJ k Q t�.� 1a g r^e S l ..-ar-. <br /> G ,4,7c '1L h.- e.tec —rtL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units ( Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <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 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 /> I PER T# <br /> ek,ii, A. -11..,,c,,, 0 2— 41- 2o k � \,$)2. — op&. .._ <br /> Owner/Authorized Agen ignature Date (Revised 9/23/2016) <br />