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• PERMIT APPLICATION <br /> 12 <br /> BUILDING/MECHANICAL/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 /> (BNw or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: &O LI N 6/0/j AVe PROPERTY TAX#: Q O y 3C /(,f js03'po b <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I CONTACT INFORMATION <br /> OWNER NAME: PETE ' J i k a if TENANT BUSINESS NAME(Commercial):A:It77sMu /4t j`((i jp77€j <br /> OWNER MAILING ADDRESS: STREET p/Q 6 d,( La 3.-i-- <br /> CITY f V Il7f/T _ STATE IAA- ZIP GI,I2V /I' <br /> OWNER PHONE: a0r4 4 ys/® OWNER EMAIL: P hi i ice Ir C a 0.1 L r eG"' l <br /> CONTRACTOR NAME: El-LA/wit f j4-LtJ J�.I V f[/I_ <br /> CONTRACTOR ADDRESS: STREET 3'1e0 I Iv n f/7 AVE <br /> CrrY EV E rl STATE I 4- ZIP 9/91,6/ <br /> CONTRACTOR PHONE: `f S /3/ 1),X37-c CONTRACTOR EMAIL: i c e a IaiNcl,e r le j c(hrxlt e-044 <br /> CONTRACTOR LICENSE#(REQUIRED): ESL,AN SS O(Z is 2_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0/6 34 3 <br /> PRIMARY CONTACT: 0 OWNER a-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME::'' CONTACT PHONE: Y� )3/ .2 2 <br /> V 61 M (A ICUL ef- CONTACT EMAIL: jc el I :er e tX 4 yl cr.), LO'1 <br /> BUILDING INFORMATION ,' ; .: <br /> Existing Use of Building: CO M/t tC til C.1 t S/Vfr F Contract Price of Work:$ 000 <br /> Proposed Use of Building: cohtmolcj AL. Heat Source: Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: OCommercial ❑Acre ru ' aType of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan f e W(C <br /> DESCRIPTION OFWORK: io ExI rrj , PV KA) AcL OAa /ivy f(M Da, a . <br /> MEW IJ vci �� i <br /> MEW pue7 ►this X FA MS ?6 3 B.0`/j l o64r G ti s o U - -tow - per OFz' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,cL-L-- `f f f!� Ot,. m/t v(�1r�` ��. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION "`S <br /> Fixture Ftuture 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 /> Lf 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 I 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 lam 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# d 0 <br /> 9 <br /> O net/Authorized g nt Signature D e / (Revised 10/10/2018) <br /> 1,- - 654, <br /> 'l' <br />