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INN <br /> PERMIT APPLICATI <br /> BUILDIi` MECHANICAL i PLUMBING 1 SIG PRINKLER/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Biue or Bleck Ink Only Plass)• PROJECT SITE;INFORMATION <br /> PROJECT SITE ADDRESS: tq©1M1) 6J �'4 a„�T'L PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION, <br /> OWNER NAME: UD P iNG, TENANT BUSINESS NAME(Commercial): _ <br /> OWNER MAILING ADDRESS: smear j 7l)5 5 he- _ 1 __ A <br /> CITY , " 'Lal S STATE yell ZIP go Z <br /> OWNER PHONE: 726)4223 - . 1.2g7 OWNER EMAIL: H- 5Tal 42 0 J R. , Cor v <br /> CONTRACTOR NAME: <br /> /41 A .._Ae- Pin. <br /> CONTRACTOR ADDRESS: STREET )g % u ups J \Asti 0,5 cr <br /> CITY 6� / 6e_./T— STATE Az_ - ztP gS 24/5 <br /> CONTRACTOR PHONE:03&6)-2&2......—")g L 5 CONTRACTOR EMAIL: zzer-y- c f /1/4 W/PI r, .. Ceps <br /> CONTRACTOR LICENSE#(REQUIRED):( O ii—'9 K, )_t Li CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � <br /> PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (48o) S 13 _ 773 R <br /> m t\ F_41-A___ CONTACT EMAIL: i i i 0 /4,41,4,.. 6.)l tipi' , cet;,„„..1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 70)t 0 <br /> Proposed Use of Building: Heat Source: DGas DElectric DOther <br /> BUILDING USE: DSFR DTownhouse ODuplex OADU Multi-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project ONew DAddition DRemodel DRepai DT.I. OSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Rept ..e., c...,Pv.< w e— pipe_ p-t, i e. PIP-e� I i ice.- 1 I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureFixture 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) 31-I Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless a y 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 39 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 t SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression SystemNo.of Heads <br /> Chemical Suppression System 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with t dr: . • ctors Law 18.27 RCW and 296.200A WAC. <br /> Cray of Everett Official Use Only <br /> f/� PERMIT# 1,' <br /> II 6 O() <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />