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PERMIT APPLICATION.
<br /> BUILDINGM ECHANICAL/ 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 /> PROJECT SITE ADDRESS: 1 6 '„ // 'e-- PROPERTY TAX#: 7,c7e.C7C2z7e,46.0—exn
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,46-z.,3L-5 .0 TG^,e///it&C TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Li 3/ - yc 97/4�L:
<br /> CITY 25I✓enLr�//' STATE h ZIP 995,A0,3
<br /> OWNER PHONE: = ,Z2.----(/,/9 OWNER EMAIL:
<br /> CONTRACTOR NAME: S i-?71//04 S -7tL /C- 5 ,sf'c&jfC?,,,-J/.5,,/ CCCiC ',y//Y
<br /> CONTRACTOR ADDRESS: STREET ,re,„2( - ,/ 77/ 6/ 6[t,/
<br /> CITY Aril/l e:,i STATE 4,40.11, ZIP .9)•,l/3‘
<br /> CONTRACTOR PHONE: y"xj .....gz1,j "2_ . CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): fLJs ,�,y'„3(��'f CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) C— /67
<br /> ��; m.•• �m ,. ��� - �� .�,.,. _
<br /> PRIMARY CONTACT: ❑ OWNER $CONTRACTOR 0 OTHER(Please Specify) s N
<br /> CONTACT NAME: /VA-Mt X3z tAr.i - _4 CONTACT PHONE: 9,21.5 ,..52 g f Z
<br /> CONTACT EMAIL:
<br /> BUILDING INFORMATION
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<br /> Existing Use of Building: ,, f%f� Contract Price of Work:$_ 9
<br /> Proposed Use of Building: ,S P A Heat Source: 0Gas Xlectric ❑Other
<br /> BUILDING USE: lEcSFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition El Remodel ZFtepair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: "7�p (9 / 4. 5/-7) 9 ,, ' � {/,' 4CI.' /1'1/ /A/
<br /> L., 2L-iTY si 'e'S / jAse.:r1:
<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 /> 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/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 /> PERMIT#
<br /> 770.1i . je,-3/-40/, 'lbw tqto - Doe
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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