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ME A 6 <br /> 111114 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> .. q T T CITY OF EVERETT PERMIT SERVICES <br /> �t 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: " DO Pete) f 1 L Pc,- _ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .17cc.c A C. Av t PcSs o Citt—c.S TENANT BUSINESS NAME(Commercial): vQ4. t 86rrre, i C iu'h+ <br /> OWNER MAILING ADDRESS: STREET i i U O T Ci!` F`C.- ry'V C Ciors( 6J1-.1 STATE "`''p p"\ ZIP 61 g-'ZU I <br /> OWNER PHONE: 42-S 7I 1 &S 3 S OWNER EMAIL: <br /> CONTRACTOR NAME: Cv/.z6 .� ,59,E-r-p-; /�f-/k1�e_ <br /> CONTRACTOR ADDRESS: STREET Z(ZO (�/-i-C.� L <br /> CITY EliC�t_E:t1- STATE 14r t ZIP eil jl <br /> CONTRACTOR PHONE: I2') 2_5Z-.3 f l'-(- CONTRACTOR EMAIL: VI Cur i Sge a tW,AJR. CAW\ <br /> CONTRACTOR LICENSE#(REQUIRED): gV SSaZZdr— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OO1 9 SS <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: _ CONTACT PHONE: (Li-z.c) , -C 7Z - <br /> C1► ckx..i SCE-60. .hh Ac CONTACT EMAIL: <br /> A,r 155 e @xissen wa,, 66wt <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ /(- i3S <br /> Proposed Use of Building: Heat Source: OGas ❑Electric DOther <br /> BUILDING USE: C1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ommerciai ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ' T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: E* 1^j s -.1 `t c�g�v� <br /> artS12,C__ ff.c-Va e-i/j <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 Backfow Preventer(inside Bldg) Shower,Tub,or Combo <br /> Boiler ♦ Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer 1 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 Ventiiatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system)_ Hose Bibb Urinal <br /> Exhaust Hood(Typal)) 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 l 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 /> 1 City of/Evveerett Official Use Only <br /> S 6-Ur)��✓v�/ PERM. <br /> `L.IC.I J 2 "� O�(:\ <br /> ner/Authorized Agent Signature Date (Revised\10/10/2018) <br />