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PERMIT APPLICATIO <br /> 1 al <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN SPRINKLER I 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: SS 1 S D[z jc , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (\Ott`a1 t\tit TENANT BUSINESS I � NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET �IQ V C?v 7Z&p... � I.v / \-- 1 ` <br /> CITY L�1�C -� STATE u,..., ZIP 9'9)l/V- <br /> OWNER PHONE: y 2 - 3A1 — (�'CC KJ OWNER EMAIL: <br /> CONTRACTOR NAME: '44(Z- ,,k----) j' °c A,S`-GC-,(A t b <br /> CONTRACTOR ADDRESS: STREET (2---t2j0 oA lk-1.)V -. (TLC <br /> CITY ✓ TC--. STATE "/�-\ ZIP <br /> CONTRACTOR PHONE: 4I'S-'1 \ - b bc)t A CONTRACTOR EMAIL: r OLSOt-)e- VA OT •- WA/1;, . c c —11 <br /> CONTRACTOR LICENSE#(REQUIRED): I j Lt -\ I 1 a C.- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 04 Z-` t <br /> PRIMARY CONTACT: 0 OWNER gCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -3 , -(0b9% <br /> - _--OTC' i •-\.-\5v-L,o, .\ CONTACT EMAIL: Q. <br /> BUILDING INFORMATION <br /> Existing Use of Building: HVLISI al(;, I Lid ( Ef (CC Contract Price of Work:$ (VO100O <br /> Proposed Use of Building: Heat Source: ❑Gas atElectric Mother <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU El Multi-Family-#Units: OCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i;u-p ,fkuoji‘.k.u_-&rr 1)-f 1)-72,1 ;--F,t -lk SH-A77 rO4LZ-C"- G ,1 <br /> U 0--- mil,(-ice ('0 U" (T N --f-D e-r 1 s...-c- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 13t -t2- o14k <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 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 /> r ( 2I (( 1CO <br /> P7\IT,CrD2 - 6k L-C <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />