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MIN <br /> PERMIT APPLICATIOI <br /> BUILDING / MECHANICAL / PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES 1.. a. Q <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' 1 tvert PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision U Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial)TQylrla_ %A S <br /> OWNER MAILING ADDRESS: STREET <br /> �� <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 50.N 5bvk. F;rp', ?(D‘ef.—"6o1". <br /> CONTRACTOR ADDRESS: 11b( STREET �E 3cok 1 $rare. ?L( ' JA4.I1 BT oe, <br /> Qe4.10.vka. CITY OC apl t STATE1ZL Ui tam LA \ZIP C191‘8i< <br /> CONTRACTOR PHONE: 54? gg3 ll D CONTRACTOR EMAIL: geAS q a Sarotkf'S cvvc;cse , Ctv A <br /> CONTRACTOR LICENSE#(REQUIRED):.5m,me e?%its D N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED).' lX 12Mt\ <br /> PRIMARY CONTACT: ❑OWNER )('ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 'CONTACT PHONE: Spa iss 3 t 6 <br /> d•(� S�0.�n.r CONTACT EMAIL: grto <br /> r` Savetkt'g tk g;U�2 eb,A <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ I (*0O• 00 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ElCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: • <br /> t-Fosk Lxr h.As UkL300 •e. st,.mres5,A,r s75+ <br /> Yr tA.00t �4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 'I tket 06-(Al <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 /> 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 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 /> .pression System No.of Heads <br /> emicaT •uppression System (l "No.of Heads <br /> LEDGEMENT: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 /> r / City of Everett Official Use Only <br /> PERMIT# / <br /> (Jlr <br /> 1 09, - DO(6 <br /> Owner/Authorized Agent 'ature Date (Revised 10/10/2018) <br /> C1-22,-) <br />