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imi PERMIT APPLICATIO1112 / PLUMBING /SIGNI�PRINKLER/ 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: 2 N. toQ(_/yy)n zr e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ✓4 (? 'yeJ !'i` C 4 eQ k ((/1tiOCCA TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /5 i /7 Mai iii ,57/ (Lid 1 l y 13 Zb 5 <br /> 7 CITY /11il ( 10 Q,k. STATE 4 ZIP el' / ( 2 <br /> OWNER PHONE: iJZ 6-31— t2 7 OWNER EMAIL in v (-..•... (�ti C-q ny Y e ck O :<. t q,rii-i4, <br /> CONTRACTOR NAME: r i T i1L l 6, 6 5 (o f/1 f; I I( <br /> CONTRACTOR ADDRESS: STREET 3/7 R t :S(s y / l� Li.' i(( <br /> CITY .. ' ee STATE f •"T ZIP f e. 7� <br /> `j'-, /, L <br /> CONTRACTOR PHONE: Z/2 z 72/7/r.—___67C7_�� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) J r 7 7 2 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: I1z- -z( o .--,, ?e)4-- <br /> /(!04 (:?l +64i CONTACT EMAIL: ek.:( < f CZ F r 6G,fe+'% / : ( °AP / <br /> BUILDING INFORMATIONd�s� <br /> Existing Use of Building: Contract. Price of Work:$ /��� !`�(� <br /> Proposed Use of Building: ; rD iv 02 Heat Source: ',Was ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU OMulti-Family-#Units: ti Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> [.v Q2 ccw -11 e r7 f! i o vtil tut S liktilikcco wt.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 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 14 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior .2 Floor Drain L-/ Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb .Z 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/InserULog 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 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# <br /> / ' ,�G �(s—( V�o �f- 003 <br /> Owner/Authorized A nt Signature Date (Revised 4/15/2019) <br /> rrie/4( Gt& <br />