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PERMIT APPLICATIC. <br /> BUILD I MECHANICAL I PLUMBING /SIGI PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e7T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: 1(2 l Gte lv PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Cp�Z,P Yn a W <br /> CITY W �Q - STATE J ZIP <br /> OWNER PHONE: Y�- o �j OWNER EMAIL: ow yi o n e_eb <br /> CONTRACTOR NAME: �G, �j� <br /> 822 5 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY n w O v STATEy, WA ZIP p v <br /> CONTRACTOR PHONE: — 7 -- v CONTRACTOR EMAIL: I JLC ''LQ s; --V65) <br /> CONTRACTOR LICENSE#(REQUIRED): LVH(7E1 -(4T_ -76L 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): p acP-1=> <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> cO\ (Lu ya CONTACT EMAIL: 5.� ooi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t ' <br /> Proposed Use of Building: I Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition []Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1G <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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/SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT.•t 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./am the owner, or I 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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#s ` o <br /> Owner/Au orized Agent Signature Date (Revised 9/23/2016) U <br />