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NMI PERMIT APPLICATION <br /> BUILDIN A ECHANICAL I PLUMBING I SIGN TSrPRINKLER/ DEMOLITION <br /> EVERETT' T 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: 7/// cic ea / 19 j/ PROPERTY TAX#: t✓Os-7 :3 7 -6O 9 O& 3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ipe..yl/1, , � 0E'<y► ,c1sc.- / TENANT BUSINESS NAME(Commercial): <br /> A <br /> OWNER MAILING ADDRESS: STREET // / 1— e tr Pi ve <br /> CITY (' ireV, 'TT STATE ,`01Q ZIP `/ Gl7�202Q 3 <br /> OWNER PHONE: / I WNER EMAIL: 111 <br /> CONTRACTOR NAME: 00 I/ L L r V 1,N. 2 • <br /> CONTRACTOR ADDRESS: STREET t;EiF �(2�, — � 'LL/ <br /> CITY /7� � STATE ��H{. ) ZIP 9 II <br /> �'' ,�4 <br /> CONTRACTOR PHONE:c27h, -9/3— �?)9 CONTRACTOR EMAIL: i'J/ rbi1i t ✓„,,A„ inv,,,I i6,,,, <br /> CONTRACTOR LICENSE#(REQUIRED): " ( ) 39 t j � � O EVERETT BUSINESS LICENSE#REQUIR� 6 <br /> PRIMARY CONTACT: 0 OWNER f0 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT/lAME: CONTACT PHONE: �6(p_ 73-- /�.-2`2'3 /` <br /> ,<a i I S��£0er CONTACT EMAIL: $ l i rkaic i'vn5ffo e'v 0--g0Ii4)i &/}1 <br /> J <br /> BUILDING INFORMATION <br /> ein <br /> Existing Use of Building: a t "xyt' Contract Price of Work:$ l ci <br /> Proposed Use of Building: ,t':V Q/;OAG- -- Heat Source: ❑Gas DElectric DOther <br /> BUILDING USE: IiSFR ❑Townhouse ❑Duplex DADU El Multi-Family-#Units: DCommercial DAccessory Structure <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ,(Change of Use <br /> DESCRIPTION OF WORK:rtth +i <br /> C 1 r 47t- 1{ ' thl <br /> Spy <br /> 4 1 - 1Li 0 Ge ea & <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) / Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer / Heat Pump&Ductless Dishwasher j 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I INo.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 18.27 RCW and 296.200A WAC. <br /> I City of fEvveerett Official Use Only <br /> ,„4,7, 7,�r /f PERM\ V <br /> .( Let/` - i /� %' ci <br /> Owner/Authorized/Agent Signat Date (Revised 4/15/2019) <br /> 2- <br />