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PERMIT APPLICATIOft <br /> BUILDINIPMECHANICAL/ PLUMBING /SIGN PRINKLER/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: Z ✓�!Y C' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/ ubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): VT t 6- S‘ C. Lzccles <br /> OWNER MAILING ADDRESS: STREET 1l) // C ve y Ave - - (' <br /> CITY c-V Bie f STATE L.4 ZIP 2h.2y i <br /> OWNER PHONE: 42__ — 2-5-2 -- 1 2 yc OWNER EMAIL: <br /> CONTRACTOR NAME: SQL„I �'°-�_ 5. <br /> CONTRACTOR ADDRESS: STREET f 9j Q214 f 99 R A- <br /> CITY 17 <br /> onti.A904 STATE VA—-_ ZIP ydD3‘ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 5r--r-pS.se-4y 1 ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):39 2-0 <br /> PRIMARY CONTACT: ❑OWNER OrCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-2 5- —y 3 __. oo 2.- <br /> ` ) ( S pa vic___ CONTACT EMAIL: iiii) . S S Glee(In 60• ( t <br /> BUILDING INFORMATION Existing Use of Building: Contract Price of Work: $ \4-3 `)j'� <br /> Proposed Use of Building: Heat Source: OGas ❑Electric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. l.letSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> JnS—��,I ci re 6.,,,, 51.7,1,1 <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) 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 /> Water Suppression System No.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 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 /> City <br /> � CC <br /> of Everett Official Use Only <br /> 82�2iJ P ITe 09 - <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) I <br />