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� <br />�� <br />F���i�IE�Y �F�PLICl��T�IC)� <br />BUIL.DING I MECHANICAL / PLUMBING / SIGN I SNi�INKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.govlpermits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �3tD C���1, S,t• PROPERTY TAX #: DD 3�t D8 o2oc3oo, po ��jp 0200�0 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �i �} s � }�/y (,,�.•G TENANT NAME (If Commercial): �L L�7 'h �. <br />OWNER MAILING ADDRESS: sraEEr 33 �o G Pi� A� S <br />CIT1' �� STATE ZIP qg� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: srREEr <br />CIT'f 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: CONTACT PHONE: ��j �Cj� � y��sj <br />�a�ni�`v �aw��Y` <br />CONTACT EMAIL: dqy�j` le 2gj'j�AfG�11 �Glr�'L�.YGrGoCN <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: � �i" Contract Price of Work: $ Sd O <br />Proposed Use of Building: t!' W A Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑ FR-Attached ❑Duplex ❑Multi-Family-# of Units: Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � '7LD SQ �� � �qb 1/�O OM w �'�'�� „ A� �X� S� V1 G� <br />� J <br />��rcwc ��j - <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn __Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #�f List of Fixtures #�f List of Fixtures #°f List of Fixtures <br />Fixtures F=ixtures Fixtures Fixtures <br />A1C — Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub Urinal <br />Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap <br />Gas Range Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood Water Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRE:iS10N SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: I have reviewed thi:s application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comp/y with <br />current federal, state, and local law. The grariting 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. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />. � <br />OwnerlAuthorized Agent Signa <br />� 3.23.1(� <br />Date <br />City of Everett O(ficial Use Only <br />PERMIT # <br />a I (����' - D� g <br />(Revised 10/12/2015) <br />