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= PERMIT APPLICATION <br /> BUILDING ECHANICAL I PLUMBING I 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: T •I.- 1 Birt..`: i`I (le- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: irjtt,,,, �(:\(',Z TENANT BUSINESS NAME(Commercial): <br /> -7 <br /> OWNER MAILING ADDRESS: STREET 6 8 gj 13eu t L( Z <br /> CITY EUeX(-H' STATE V A A ZIP .& 3 <br /> OWNER PHONE: OWNER EMAIL: ������JJJ <br /> CONTRACTOR NAME: F�3E V(L cd f'yct,vtli vt - L LL.. <br /> CONTRACTOR ADDRESS: STREET P.Q. l DX - L L(65 <br /> CITY ( ve-re -' STATE W., 1 . ZIP 'WZ. o f <br /> CONTRACTOR PHONE: (0z5)42. -S-ii5.6 CONTRACTOR EMAIL: CSt'. h c-fet.rtlii cL�yr&Lt(. C'_, tt CONTRACTOR LICENSE#(REQUIRED):CC 6 56-t-A1I F.'s,/'j/VU CI OF EVERETT BUSINESS LICENSE#(R UIRE ) \ `� T' <br /> PRIMARY CONTACT: 0 OWNER IYCONTRACTOR 0 OTHER(Please Speci y - <br /> CONTACT NAME: CONTACT PHONE: /.iL)t .— yy7 �.—fi v <br /> cj'L IC.I If( i r}Z/ CONTACT EMAIL: <br /> r BUILDING INFORMATION <br /> Existing Use of Building: irvLft- G?- i1li/y Am,/ c 5 Contract Price of Work:$ _�1,// <br /> Proposed Use of Building: / Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ESFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Oj icl w,,,, ci, ,,_:1/- ',:i.cicli 4-14,v, 1-o (i)c) 1(LAO <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 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation 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.I am the owner,or!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 /> G� City of Everett Official Use Only <br /> i <br /> ,/t? ,d <br /> PERMIT <br /> ner/AuIhorized A/ 4i <br /> nt Signature Date (Revised 4/15/2019) i <br /> Z. <br />