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min PERMIT APPLICATIO, <br /> ra <br /> BUILDING ECHANICAL/ PLUMBING / SIGN / LPRINKLER/ 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: 'ZS O'- Po t,,grcn Ave PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • CONTACT INFORMATION <br /> OWNER NAME: /�i) e 5 e`c(i f.- 5,On TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 t.:)c Li ran W GkY' ( A v(> <br /> CITY f- I/R,/FJ.r-t" STATE '\A/4.3k ZIP 9 V 2,G 2) <br /> OWNER PHONE: o.-O6 - 2S N?3ej3 OWNER EMAIL: 0-1/Sei'et j ,l'--e-t t;l YeA ktoo °c-c,<vl <br /> CONTRACTOR NAME:Arrowfire Protection <br /> CONTRACTOR ADDRESS: STREET 140 Mountain Creek Drive <br /> CITY Cle Elum STATE Wa ZIP 98922 <br /> CONTRACTOR PHONE:(425) 301-8707 CONTRACTOR EMAIL:Arrowjd16@gmail.com / <br /> CONTRACTOR LICENSE#(REQUIRED):Arrowfp847pk CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 V 3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425)301-8707 <br /> Jason Duby CONTACT EMAIL:arrowjd16@gmail.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ i,ana <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑g-FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:: - Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I.❑ ❑Sign SpL� rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> D Pass-`,i‘e._ r U ry <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures cosine 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 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/ SUPPRESSI9N SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads 2-1 <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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> s �, / ' Z( PERMIT# <br /> ►,/ — 6 — ` -�A 0 44 _ 0OS <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) 1 <br />