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mum PERMIT APPLICATI <br /> Ns <br /> BUILDING MECHANICAL I PLUMBING / SIG , 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)eas- PROJECT� SITE INFORMATION <br /> PROJECT SITE ADDRESS:$SGj 5CJ3' 7Zc//�1167.ki tJ47 PROPERTY TAX#:'2 864/3 Q (d 3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: grt7)16"Y 4'+ -1 ZM PJ'*iI,TENANT BUSINESS NAME(Commercial):.L4 V.16A72, 6J t <br /> OWNER MAILING ADDRESS: STREET �2 9,� (�'�9 `�7 ? - <br /> cITY Za �/�►j7 1 `� -`� ) STATE Iti A' ,/ ZIP /��'Z 3 <br /> OWNER PHONE:2,53...lel- Sip 6 ` . / OWNER EMAIL �Tr 6 CA; e'i 4 40%64 IN do...„ <br /> CONTRACTOR NAME: W 6 Ni I.I.",6 <br /> _CONTRACTOR ADDRESS: STREET 325` 24 5,4/NG 72 AI *1 39 Q <br /> �CITY N ,�"'r- STATE G( ZIP 9 j 2 <br /> ~� <br /> CONTRACTOR PHONE: •3g,a.... O l T O CONTRACTOR EMAIL: + C 4- GL..C°. ., V akAA..,v, <br /> tit 404 <br /> CONTRACTOR LICENSE#(REQUIRED): // <,44 4 5f AZ t. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �'SC� / <br /> PRIMARY CONTACT: Cl OWNER IISCUNTRACTOR 0 OTHER(Please Specify) <br /> CONTACT•NAME: `� �kM LLCM �1. ^CONTACT PHONE: ''�,6G 37/ . d /44 P ,/ <br /> —..J If 7 �J A Q CONTACT EMAIL: Hick) L4,A-.. e. (D'(.UfRY U• �:�eit/ <br /> BUILDING INFORMATION <br /> Existing Use of Building: 14.1(ft .......--. A.C Contract Price of Work: $ �f <br /> Proposed Use of Building: EJ161 . vo <br /> "7r rag) la-4ri Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. `Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: O W�i�d��+ �`7�4�-t._ S'G+iS ©� �u/'-72 ,47� #3'�b <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .(I d ci .. O `T <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 /> NC—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 I 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.lam 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# ^ V161 f 061 <br /> liCilk ` <br /> Owner/Authorized A•it Sig ,ture Date (Revised 4/15/2019) fT <br />