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min PERMIT APPLICATION'I, <br /> ELI <br /> BUILDINECHANICAL/ PLUMBING/SIGN I.DRINKLER/ 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Buie or Black,Ink Only Please)` PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2i9 2,0 um y * 5; (jitv,..e.4 (./jl PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT.I NFORMATION. <br /> OWNER NAME: I L. a vi 5 o/,(a--{ k-- TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADD I ESS: STREET y20 WO, QIC k SE- q <br /> CITY ., STATE V - ZIP C11V <br /> OWNER PHONE: _ OWNER EMAIL: <br /> ..�., <br /> % — <br /> CONTRACTOR NAME: C,(14/1 �'Cp_ �� <br /> CONTRACTOR ADDRESS: STREET t5)(?)0C-( C3CUJ I/I t' (1/ ,/014) <br /> x <br /> CIY� ` (4'at; c� STATE I_a AA ZIP � �� <br /> CONTRACTOR PHONE: (42. ----___ t-(22-�1 2r) CONTRACTOR EMAIL: IANALS)09 (kd C(-,ems �O(. /), <br /> 1 <br /> CONTRACTOR LICENSE#(REQUIRED): AYIFE_ �62-Ie„,f_ CITY OF EVERETT BUSINESS LICENSE#(RE r I IRED):a ° • + <br /> PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:- 3 sf ^ CONTACT PHONE: L. j S_ C f -T4-2-2) i <br /> � 1�n� CONTACT EMAIL: IAaw ��'b t ),j4 i(t'e „a0c cot'- <br /> . euILelNo. ioo.oRmAllor .., <br /> c' <br /> Existing Use of Building: <br /> . Contract Price of Work:$ V ,Q5071 <br /> Proposed Use of Bui ding: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: FR ❑Townhouse ❑Duplex :VDU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addiition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: iie4436 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ` MECHAN1CA4„PERMIT,APP,LIC.A1TION .' . . PLUMByNG;1"ERM1T APPL;O:411oN, <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count 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 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 I,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, ,ate,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+,efore 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 wit',the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of RoclEverett Official Use Only <br /> 1104. IT#.1(( 110(__ PE <br /> Ow,er/Authorized Agent Signature Date (Revised 4/15/2019) <br />