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12 PERMIT APPLICATIO <br /> BUILDINGOECHANICAL/ PLUMBING/SIGN MPRINKLER/ DEMOLITION <br /> EVERETT CITY 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1901 Me.tr f) '�t1,�tg, a;i'T B PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: `J,D Ps, 1vt6_a TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET795 5 - ( e-i hr' }) - <br /> CITY 1at v \a..-,-1e%1 J � CI'.\ STATE ZIP 80 1Z9 <br /> OWNER PHONE:(7202,2 3 -- 1,�0 OWNER EMAIL: YFe ./ STc i t. Q(M , [.00, <br /> CONTRACTOR NAME: AVY\A Ad, P I <br /> CONTRACTOR ADDRESS: STREET ) % i. jo S , " ._vit o S S1 <br /> CITY �1/ e› .%.1--- STATE A Z. ZIP &S 2 95 <br /> CONTRACTOR PHONE:( y— L— 'g(5 CONTRACTOR EMAIL: gc)Be--cr 62. AMA-tV1P, . (:. --'t7 <br /> CONTRACTOR LICENSE#(REQUIRED):60 4 -9 / .>"-) �l 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l,(.Lt 7 W <br /> PRIMARY CONTACT: ❑OWNER IXCONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6 0 553 — 773 C� <br /> �c, ; , Fe ST CONTACT EMAIL: VV1I ,4i,4. 4 ,iP, , c -- <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ._3 5 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric DOther <br /> BUILDING USE: MSFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Repko 6_,F7 c2 6_ wa ,-' Ph, it jr Pe lc. " I P i 1 I -ii II '- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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) ,2 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless ) Dishwasher 1- Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential), Commercial Ventilatior Floor Drain ,j2 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 /> 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 uthorized 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 Ste ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER <br /> k l- tom- cot T [1,-k< < OAK <br /> Owner/Aut rized Agent Signature Date (Revised 10/10/2018) <br />