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Elm v 6° PERMIT APPLBCA TIC <br /> BUILDINU I MECHANICAL I PLUMBING I SIGN i kPRINKLER DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �c5 ,� _ ' � � (/ NL.cs PROPERTY TAX#` 1.37&'--��eor).. —CU <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /404,._ )4 :.W,A-GG TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET la <br /> CITY -77A-444/pSTATE 6✓✓/ —. ZIP C/.9.)-7/– <br /> OWNER PHONE: fit%' 4t 1)- OWNER EMAIL: [Z.IZI t' @/401-- Ce)M <br /> CONTRACTOR NAME: ) <br /> CONTRACTOR ADDRESS: STREET .jI - �4 ��N� �G/ <br /> CITY I V 1(417-y1�ifi✓�,- -6 STATE IA-14 ZIP a)-7 <br /> CONTRACTOR PHONE: ,7.1.)6, 7Icf 6 .) CONTRACTOR EMAIL: L.A.4>A-5Acg ejv ,J <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: 7/q ��- CONTACT PHONE: <br /> 441 -0713,44772- / CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: 6 (2- .Contract Price of Work:$ J � <br /> Proposed Use of Building: 64\41.1}6 .- Heat Source: ElGas ElElectric 21.Other ; U/ <br /> BUILDING USE: ❑SFR ❑Townhouse El Duplex DADU El Multi-Family-#Units: El Commercial QAccessory Structure <br /> Type of Project: E1,New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ypDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: I>e:146-A-414-6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,Ni.jC1 1 (R — <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/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/InserULog 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 nder 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 Contrac s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> u� <br /> Ki, 61 <br /> fled, . ••riz-,t'rn.Signature Da (Revised 4/15/2019) <br /> 61VA . .. wMO eon l <br />