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A PERMIT APPLICATI <br /> BUILDING / MECHANICAL I PLUMBING / SIGN SPRINKLER/ 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 /> -a��4q <br /> 4,Y w ^ fi---il f`-, <br /> PROJECT SITE ADDRESS: O 77, I I L`' /vi ".1 0 , t rj 'j' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (lie, TENANT BUSINESS NAME(Commercial):LS Li l + LS <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: q2 S 2 713 rJ i 3 OWNER EMAIL: Ct7PZo ei el wf'sj Ic ke s1uc r e5• c b^-A <br /> CONTRACTOR NAME: aJ+a r- • n 2 / uoi ..µi N r ')(t',"t 3 iti Ai <br /> CONTRACTOR ADDRESS: STREET 35��' )9` t P J- / y <br /> CITY (,R i \-I STATE tAl l ZIP 9 (i ? F-...\ <br /> CONTRACTOR PHONE: (4175) `1'17- 710 t) CONTRACTOR EMAIL: , n i'./0 pi.MIA,vc"( el toe, {5 oti.., ^, <br /> CONTRACTOR LICENSE#(REQUIRED): PLU/110 rN$?-3N H CITY OF EVERETT BUSINESS LICENSE#(REQ IRED): 1 (; 5 G 2 <br /> PRIMARY CONTACT: ❑ OWNER .0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( L1?)) 5 ,-0,-- 7j- --, . -"3 <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: ( >,c"�1.-\\, Contract Price of Work:$ "1 ,OO 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU Ed'Multi-Family-#Units: lg OCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION 1 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 /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) I 0 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless g Dishwasher sc.Q --Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 j -Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) . 71-lose 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 fj' ...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 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 of Everett Official Use Onlyly <br /> PER�iIjl \\O CJ'4 <br /> Owner uthorize A e t Signature Date (Revised 4/15/2019) <br />