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MI
<br /> • PERMIT APPLICATIO
<br /> MI
<br /> BUILDING/ MECHANICAL/PLUMBING/SIGN / 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( www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS:/46X 5/ 4 2 J‘,/ r/9tZ,77--- Y,e,i PROPERTY TAX#:,q42#LOW/6/600(1O'7OO
<br /> LEGAL for new construction: Short Plat/subdivision ,go.?l.)c3'r 7Y'00 Lot No. 6 (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: )(JfZA,y/ 4,,iy,,-✓�� a / ,„,,,,�/ ._ TENANT BUSINESS NAME(Commercial): f/74
<br /> OWNER MAILING ADDRESS: STREET -?/.1/ J / �.j
<br /> CITY 4/.31,yeZr_r--- f STATE 440 zip ��6,
<br /> OWNER PHONE: 25. _ 7/YLZ.? OWNER EMAIL: fr .' &' /z, CSC-2')
<br /> CONTRACTOR NAME: / . 1C/,
<br /> CONTRACTOR ADDRESS: STREET '". ,f g
<br /> CITY •C-/ Z4 /T STATE ZI ZIP ff,..2Z,V
<br /> CONTRACTOR PHONE: / 9—
<br /> 3 74'Zi' CONTRACTOR EMAIL: 70144911409. g /Ai r 41
<br /> CONTRACTOR LICENSE#(REQUIRED): j4/"f/if/i' eyer..� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 09/7(7
<br /> PRIMARY CONTACT: A OWNER 'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ' '— "�' ''pi/A'�
<br /> '774 (./ a11,97 CONTACT EMAIL: redn,�f , vL.4,,v,Z/`' (4,./AiG,./
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: A// - Contract Price of Work:$ �A:.3 CVO
<br /> Proposed Use of Building: c--;,, 1 Heat Source: AGas ❑Electric ❑Other
<br /> BUILDING USE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: New ❑Addition ❑Remodel ❑Re air T.I. ❑Sin ❑S rinkler ❑Demolition ❑Chan a of Use
<br /> YP � P 9 P g
<br /> DESCRIPTION F WORK:
<br /> A/A). cofifiwre-i7m, i'A'4 gbor- of-ti A.9- 496,9714;—- .1,a77 A
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): LP Al ' 2 .0 Ig-' V I. CO
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Cou List of Fixtures Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping C4242ckflow Preventer(Inside Bldg) 3 Shower,Tub,.orC mbo
<br /> Boiler j _Gas Range f Clot Washer Sink-Cemimercial(3-comp,prep,floor)
<br /> / Clothes Dryer i Heat Pump&Ductless / _Dishwashe .,Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain e Sink-Utility,laundry,mop
<br /> 6 Exhaust Fans(Residential) Commercial Ventilatior Floor Drain I 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 /> I Exhaust Hood(Residential) Wood Stove Interceptor-S it ter Service(behind meter)
<br /> Forced Air Systems Other: Medic as Water s or Fixtures
<br /> / Gas Fireplace/InserULog of Drains / Water Heater
<br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System INo.of Heads
<br /> Chemical Suppression System I iNo.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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the S te9ontractors aw 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT
<br /> 7 ,fin
<br /> Owner/Authorized Agent Signature Date vised 10/10/2018)
<br /> ILIOZ. 0415 NotD2- off
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