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PERMIT APPLICATIO <br /> 1112 BUILDIN ECHANICAL / PLUMBING / SIGN PRINKLER / DEMOLITION <br /> E V E R E T 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: 3/ t : t '141 PR/V . PROPERTY TAX#:A9 4/4OO '5 c <br /> -LEGAL for new construction: Short Plat/subdivision/fd;G/i.. 14P1br2—t,XD Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: . ,- U// 4P/1 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 0. .l C.0RP/Ai port l/6 <br /> Y Izf 7 T CITY STATE iN4ZIP /$Z c.4 <br /> OWNER PHONE: 4f•-75'4/g-/73 7-- OWNER EMAIL: /✓j10L/,b S 7/1'!C�//e-OJ 7 <br /> CONTRACTOR NAME: t�/4//�/ X '/ ` <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: l CONTACT PHONE: Lz�j.• L�/$ - /73 Z. <br /> , 'diA JI/t'f21L/ CONTACT EMAIL: bjrwiph, 4 ) el0,1,i4i !_o/4-7 <br /> BUILDING INFORMATION <br /> Existing Use of Building: '�/4e.,5c -C / eS,d2hf7A/ Contract Price of Work:$ ' /, 73 <br /> Proposed Use of Building: A, 0 Z.,• Heat Source: ❑Gas VElectric DOther <br /> BUILDING USE: ❑SFR L iTownhouse ❑Duplex L IADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ElNew ❑Addition ' j tRemodel LiRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: An G>�`G11/,iw ,f ,t /5/79 v.y lOr•ri4 v ctj/riff "7/1 7O f-`je�r/r—Q�" 1 <br /> Y"GS/d€, -< aed 4" aGG�55d v `J'vi/d`✓/f , /v 5 repo vim.//o.-7 Q.i'A.-- . .iC- by/lofi._. <br /> .' 2 t ./ es9v/G�-P 4Pm QGG.c�j'✓T wGl/i'2f LJr//?t I / <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 /> 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 4 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain - ink-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 V Water Heater <br /> SPRINKLER / SUPPRESSION SYSTEM Sewage F,jector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEC GEMENT: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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �, ;' PERMIT# <br /> ,t .� l/ 1'< ,;S!f ./ <br /> t t <br /> Own r/Authorized Agent Signaturle iib- Date (Revised 10/10/2018) I/ <br />