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PERMIT APPLICATIgh <br /> in <br /> BUILD,/MECHANICAL/ PLUMBING/SIGSPRINKLER/ 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 /> #Bluleor Black Ink,Qnly Please) a,,,, PRQJECT$SITE;,INF ORMATIL 1tF „ <br /> PROJECT SITE ADDRESS:l(2 I S t/ "It to -L.c ZOO PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> iV'I'ACT)NPO ,P <br /> OWNER NAME: ch[l'evirkitsk (01Av►:Fy 1 I 1 rr TENANT BUSINESS NAME(Commercial): SVAot�e.l~, <br /> OWNER MAILING ADDRESS: STREET ///ZI SF CVfif rW t (./344-/ i ScAl---P 20, ^/�/ (� <br /> CITY &l� / STATE 1 r I \ ZIP ia7 (E) <br /> OWNER PHONE `t[SJ c(0 -3,� �{ OWNER EMAIL: S� Sno , or r yw II <br /> CONTRACTOR NAME: 3 D A <br /> CONTRACTOR ADDRESS: STREET 4.0 I>C 12O fC�,? 1 I�j{��/]��j <br /> I CITY FI/ STATE 4�,/ ZIP ` A/1O'� <br /> CONTRACTOR PHONE: ttaka JL ko -.S311 CONTRACTOR EMAIL: 2-e.EW 3c (lso' .Core, <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):''�I (o'0 <br /> PRIMARY CONTACT: N OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A,i`j50`A CONTACT PHONE: trA S_ 2 Cr 6 — I}1"') <br /> CONTACT EMAIL: r <br /> S C ,�� f §�fB X. { 1t f SnN, <br /> Existing Use of Building: Contract Price of Work:$ lP'100 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure <br /> Type'of Project: ❑New ❑Addition ❑Remodel ORe air ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OCh nge of Use <br /> DESCRIPTION OF WORK: I _ j— 0.Iicft o.-. <br /> O� r e l ettolp VIA ra,i'A. <br /> I V\ eKI ST`i K3 o ice. No,.. 6-14v5 wJs See AA-3 Cor ote:fai (1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> Viz .N1.ECHANICAt PERMIt*12;14.00.IO4. PLUMB1NG,PERMIIT APPLICATION . z,,. .; ,. ,_.., <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 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 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 /> o ---- . 6 --/(— /1 PERMIT# 0 Iq D co_. 01 <br /> Owner/Authorized Agent Signature Date (Revised /15/ W I.PA\ r/ ,/, <br />