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� <br />� <br />� <br />PERMIT APPLICATIO <br />BUILDIN�ECHANICAL / PLUMBING / SIGN PRINKLER / 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.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: ��p Z� <br />OWNER MAILING ADDRESS <br />STREET ��j G <br />CITY � (��� <br />OWNER PHONE:��'!o -999����� <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: sTREET <br />GTY <br />CONTRACTOR PHONE: <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ,�OWNER ❑ CONTRACTOR <br />CONTACT N E: <br />�/2� �ya �✓ <br />TENANT NAME (If Commercia <br />/Zd�}-/, !it/�.5+-Gl <br />OWNER EMAIL:�� <br />CONTRACTOR EMAIL: <br />STATE �v ✓.T� <br />r�. �r1oN� .@ <br />STATE <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: �� `���� <br />CONTACT EMAIL: �-�Q . � � <br />� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �/� �� Contract Price of Work: $ 2-� <br />Proposed Use of Building: ��'�(�'� Heat Source: as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition �emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: ��� v 4e L t���o2iai2 O ��/� Q i�i/j� �,ZNCG �/s� � <br />Ld I N � OL✓ f � T .s? / .o � -r _ -�r�-tO�F•�—�s'�_�-7v--�- <br />/�--ron--sf ��i ��'a^s � � j s► �� v� ►F ���-v-_.�... i7 �'i N e /� � � Li �n/ � �_ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fi tures List of Fixtures <br />A/C - Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />.� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <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 />cu�rent 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 wo�k for which application is made, <br />and 1 comply with the State Contr�ors Law 18.27 RCW and 296.200A WAC. <br />Date <br />City of Eve�ett Official Use Only <br />PERMI # � ' <br />i �� � <br />(Revised 10/12/2015) I /� <br />t / ,✓ <br />