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MEM PERMIT APPLICATION—
<br /> BUILDING= ECHANICAL/ PLUMBING /SIGN ' RINKLER/ DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Qnly Pleasej.. .,; PROJECT SITEINFORMATII N.,.. , .. j ,. . . ..,,•:;Z ,.....s., , .,
<br /> PROJECT SITE ADDRESS: 3,32n C4 c,6 AvG, eVG lrr_}}. (A,A PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT.INFORMATI ON
<br /> OWNER NAME: 'Pe.ky "RueVAi. TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 33Z6 6GckC-5 R.Jc
<br /> CITY Lvcrye,k+ STATE co p. ZIP 18�
<br /> OWNER PHONE• C L J LJ ^IOWNER EMAIL:
<br /> CONTRACTOR NAME: C`5 M K t_LC
<br /> CONTRACTOR ADDRESS: STREET 14.221 551H lycli jak.
<br /> CITY r(60ey 5V Aid- STATE (,t)Y.t' ZIP 9 69�p
<br /> c •
<br /> CONTRACTOR PHONEU-12_5) 34141 .-ti.1.6, CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): �,1„
<br /> J2EFOFEVERETTBUNESSUCENSE#(RD) ' tM,v"K«„mss.. �p,,
<br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (( j) 9'31 -6146
<br /> CONTACT EMAIL: Cl 0,wrtyil b b Yc y 01st
<br /> Existing Use of Building: Contract Price of Work:$ U, 6 iqcf•K
<br /> Proposed Use of Building: Heat Source: ®Gas ❑Electric ❑Other
<br /> BUILDING USE: EISFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: T1ti5 t1/4. New ht'PI SRP iCicncy cvr h‘tcc. ,(.h) Co ,i'C'' uh'k, Re-?KY.- 6) a 19,4-1-to'''‘'” IV"(hi-le,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> i i ESHANIGAL°PERMIT APPLICATIQI , = .,.... .
<br /> < , . ,:PLUMB010RERlY1KT APPLIQ,ATION,' .....,-
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> V 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 /> buct 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 /> , V Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER t 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 /> PERM
<br /> LA
<br /> � ► ,�ti„'c-1� Carr° at le S i/9 V\O �-00
<br /> Own uthorized Agent Signature Date (Revised 4/15/2019)
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