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i4 .A-;0A) <br /> z r PERMIT <br /> � \9.,1�r,k� �. 7 0 ®`� APPLICATION <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 <br /> PROJECT SITE ADDRESS:, 110C 54\-t( -et/4-ZTr Imo- `.i\totth PROPERTY TAX Mac:3 053 GICC4I In :. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'CQ & 1' A_u_ Q.Q. TENANT BUSINESS NAME(Commercial)k'o e1 0/...y.e <br /> OWNER MAILING ADDRESS: STREET J 01 11 IS i to 2 1 L 4f 7 <br /> CITY CA) ( IJl d ir'f% STATE ( 9 IA ZIP 1 S r.V 74. <br /> OWNER PHONE: $ II 1 1(i a-" Al 00 0 OWNER EMAIL: <br /> CONTRACTOR NAME: Pr- A VR,v c 4_ esiv 5 <br /> CONTRACTOR ADDRESS: STREET i 3.1 ' S - / <br /> CITY A- \4 'V ,,4_..N 0,./ STATE ki A (y ZIP 1 D L4 <br /> CONTRACTOR PHONE:,+c 1•-qr./- S el J i CONTRACTOR EMAIL: A-S L., Pe-ki" 7 t-(i(}-m.4•;1-. L C:►l-7 <br /> CONTRACTOR LICENSE#(REQUIRED):,/q b V/tNS Lc%1 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER -CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ` �- CONTACT PHONE: �S' mil 3 - ) _ 5 1-0 of <br /> ad 1 ? y 1C�l CONTACT EMAIL: i-S L .i'ti'*-►.•- 6"A.;a.,c6 0-1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: C zj ti4.vJCC, #A. Contract Price of Work:$ a.,0©C..) _ <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other _ <br /> BUILDING USE: ❑SFR ETownhouse ❑Duplex EADU ❑Multi-Family-#Units: , Gommercial ❑Accessory Structure <br /> e • <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Agn ❑Sprinkler ❑Demolition ❑Change of se <br /> DESCRIPTION OF WORK: J <br /> iCed <br /> 1\11 1 N- �jr <br /> I ) L,c b G .n/ls)q—"\ 1 A-c-k;r v1 N‘ ; 5 rj Vl <br /> 4,41e of <br /> 11/4/f3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S. 0 1 Cl',6y1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures calm 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 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 , 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/am authorized by the owner of this property to perform the work for which application is made, <br /> and I omply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �y gVilcfill <br /> IT City of;E,vverreetttt Ofcial Ussee Only <br /> �'_� 1 \ - 16'aoPEG�1 "t' G.7 <br /> 1 <br /> Own /Authorized Agent Signature Date (Revised 10/10/2018) c'2co1 610( j <br />