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PERMIT APPLICAT <br /> BUILDIe/ MECHANICAL / PLUMBING / SIG 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 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2-ti L-(a DSO et- • sc-- (TEA 1&2_03 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: '( ''- t�l/ �L"to L' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET - Z.t{Z "f iS rZ <br /> CITY ��=— ��i STATE VV 17 ZIP ✓�& � Zj <br /> OWNER PHONE: (-12. S — ' S " v l 7 OWNER EMAIL: PA C t lt'i 11-N le„)Ira c H/9 IL , C Obi' <br /> CONTRACTOR NAME: C1 t;.r IL' t <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE Z P <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Cl OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L{ Z yS "I l 4 t/ <br /> p pctl L rVr 14r, CONTACT EMAIL: iF'13 l i Pit'sc 'i c� 67N0-/L <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial fElAccessory Structure <br /> Type of Project: GNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 7i '7 <br /> /A y.A I 3+0 (vo e c0 <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) I . Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer ' Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher eL.r� - Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain rtff 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: Medici Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog 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 WAG. <br /> f�1[1 <br /> City of Everett Official Use Only <br /> PERMIT# <br /> L <br /> Owner/Authorized Agent Signature Da e (Revised 4/15/2019) <br />