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• PERMIT APPLCCATOOP• <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q.O(YA, IA) ;) .c ;ill D , P-RQPERTY VTAX#: .`?0 5 I%O 0 1 O 1 '?O O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAMEIVISNI5 .+�,a an difrapj PA k u L P TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET IS CJ Q '—t ;` !14 A-V F CITY STATE 'tJ ZIP 41 \Q tit <br /> OWNER PHONE: f 0 6 ¢- '6, —5 7.t ! OWNER EMAIL: <br /> CONTRACTOR NAME: ',e,,01 r,i 4 <br /> CONTRACTOR ADDRESS: STREET z/ 9 Gt./ oktiv EA,/ 6 4,V.0 E B.CITY ' ,r t(°" if r7'*�f STATE 19.d ZIP O ty.5 7/ <br /> CONTRACTOR PHONE: fo '.' -6 'b - CONTRACTOR EMAIL: ji " (.:",/ 1.7't2 r.41.i <br /> OF EVERETT BUSINESS LICENSE#(REQUIRED): 5..:3 <br /> CONTRACTOR LICENSE#(REQUIRED):��'�;,�1 :l;�k,���y�� CITY <br /> PRIMARY CONTACT: 0 OWNER E? ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z 0 6 - 5• -4 <br /> 0 CONTACT EMAIL lso°{ ._ ce,ALL . .‘ . c <br /> Aft <br /> BUILDING INFORMATION <br /> Existing Use of Building: I , ";,' " 'Contract Price of Work:$ / 7 <br /> Proposed Use of Building: /✓ t ; `y" Heat Source: ❑Gas lectric ❑Other__,, <br /> BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU L Multi-Family-#Units::r3 OCommercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition aemodel CI Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: t",d., � tat,j '_ t.€f4 , 4fa ;c 0 s , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): i`.) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture <br /> Fixture List of Fixtures Fixture . List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <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 /> Dud System(i2emodelj i2etrigeratien Drinkin 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 /> '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 under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#260 l 620 <br /> //7Owner/Authorized A nt Signature • D e (Revised 4/15/20M // <br />