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12 . PERMIT APPLICATIO <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION a <br /> PROJECT SITE ADDRESS: -7 66 \ e Ik.CCceQ.r/ U C Svi y PROPERTY TAX#: OQS 57cb C)j"J O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (O ' ki•,(A\ : CAA CAce._ i IA-2 A ZENANT BUSINESS NAME(Commercial):W f s1--,AA ; Q <br /> OWNER MAILING ADDRESS: STREET Fi' ) JL]CJ le)0 s E-Ni - <br /> CITY S,r°l� P 4J-tC) 1 (' STATE I y- <br /> ZIP X7/ T <br /> OWNER PHONE: OWNER EMAIL: t.Tst i -A-y ;1,./. C©w t <br /> CONTRACTOR NAME: AA '()AA/CRC..St Sit l/vJ <br /> CONTRACTOR ADDRESS: STREET 4 r,74 S''r N U C - <br /> CITY A,\,t,'bi.",,f/✓ STATE A- ZIP 17lC30 1 <br /> CONTRACTOR PHONE —`)8?- C 9 CONTRACTOR EMAIL: Ct\S C., _r,,h 1+ (3.-v \ ;Ls.CC 144 <br /> CONTRACTOR LICENSE#(REQUIRED):A1j V^/ L 'N). CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 8t.ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: as-S- /6 7 r.5'"O 9 <br /> 9 t , ' k isC CONTACT EMAIL: QSC, C-14,-1► r<-,g_ . /._4_$6...o . Cc/vt <br /> BUILDING INFORMATION <br /> Existing Use of Building: C 0 VI-.11.E).5 C;,!S L Contract Price of Work:$ 1 J C C <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex OADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. • ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:jpj 6"t'Rl /� <br /> � xD7 4 a, N.lj�l 1-+2 l41t^\\ tic /A 4-6 <br /> gn <br /> t,�; N? c. rak...i,A S <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 Ust of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> - <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 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 c ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 6._ 0 2��e) PERMIT#C\>!�t/��y <br /> O er/Authorized Agent Sig ature Date (Revised 10/10/2018) <br /> tk_____ <br />