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MIN PERMIT APPLICATIO <br /> 12 <br /> BUILDIN.VIECHANICAL / PLUMBING / SIGNORINKLER/ 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: 30/ E. SI f i III5 1 1je reP) PROPERTY TAX#:& C7IO O I or <br /> LEGAL for new construction: Short Plat/subdivision __ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> ;/ } I , <br /> OWNER NAME: iV 7 G�.Da1 �4�"(Y1GI cz4 TENANT BUSINESS NAME(Commercial):LASMde In - h' / <br /> OWNER MAILING ADDRESS: STREET <br /> y] o C,ol Nemile w <br /> CITY e/ere STATE ilig ZIP qg +/ <br /> OWNER PHONE:495" 3gs 4000 OWNER EMAIL: Wejo (LS-(c(e e u efeff 54>0Iq <br /> CONTRACTOR NAME: ►r )t.(?j3( Si n Int. <br /> CONTRACTOR ADDRESS: �f STREET p��® g L 9q Sato? <br /> CITY// fQILn-! Ve it STATE kr ZIP 9 73 <br /> CONTRACTOR PHONE: 3(et " 4-1 N-1 3 5 p v <br /> CONTRACTOR EMAIL: ' lm/r -! IYI e j1e OIYI <br /> ;9n•( <br /> CONTRACTOR LICENSE#(REQUIRED): 7l 4e ersc a 3d? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 7316 <br /> PRIMARY CONTACT: ❑OWNER j<CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(Q13 r 4ayr—)3aS <br /> TJ nriii C)--ttCfie CONTACT EMAIL: Pervii I4--Se411 ek'$J9f.(•?bvy) <br /> BUILDING INFORMATION <br /> a 5°oc cr <br /> Existing Use of Building: L—dl.�C.CIliZv-i /SC YtObl Contract Price of Work:$ + <br /> Proposed Use of Building: 7e Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 56ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ;.Sign ❑Sprinkler III Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 n 5{6 t 1 n Mess a-34 Ce-kr and 1 <br /> l. J Ca,bi n ei- oft �Xr s41►2-1 <br /> Bole <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 Ventilatior 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 Ho9d(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> _Forced,At Systems Other: Medical Gas Water Valves or Fixtures <br /> Gaszrireplace/Insert/Log Roof Drains Water Heater <br /> ,SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads ' <br /> , 'fiemical 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 Only <br /> I PERMIT# <br /> Ow er/Auth r ed •ge y ignature Date (Revised 10/10/2018) <br /> 1/7_ <br />