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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:Z 7v vL PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No.; L 3 R(attach copy of long legal description) ?' — 1-� <br /> CONTACT INFORMATION <br /> OWNER NAME: 70 i vo ;E Ayr LL_L TENANT BUSINESS NAME(Commercial): <br /> ff <br /> OWNER MAILING ADDRESS: STREET C77 L �TV ' <br /> CITY �� STATE LJA ZIP <br /> OWNER PHONE: OWNER EMAIL: Zy ,, Z 1.4A 614-14 <br /> CONTRACTOR NAME: 5x2L' (JT <br /> CONTRACTOR ADDRESS: STREET Q Q UL , <br /> ' 1 G� � <br /> CITY L U` H V✓ STATE LJ ZIP / L� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: g5�C[) I/'1 <br /> CONTRACTOR LICENSE#(REQUIRED): ',C COMNL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 L S !3 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NA�ME::}� CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: ' /r �" Contract Price of Work:$ . <br /> Proposed Use of Building: *.rT+yG U?'j Heat Source: ❑Gas []Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure <br /> Type of Project: []New ❑Addition Qkemodel ❑Repair ❑T.I. ❑Sign�/�❑JJSprinkler ❑`Demolition ❑Change of Use �'k <br /> DESCRIPTION OF WORK: ,6 vb — j � J"/��J/4LLf n/C7 �,✓tiYJ�E /IIVUJG firms <br /> L:kM 5T I11:,P 40Alo, SOV4, 1''' d <br /> Azad <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Vv 9,C)U <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 PumpBDuctless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type 1) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type 11) 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:1 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM# <br /> r/ uthonzed Agent Signature Date (Revised 1011012018) <br />