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PERMIT APPLICATIOF- <br /> kAD MAG I MECHANICAL I PLUMBING I SIGN)SPR3NKLER I DEMOUTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: / !l <br /> { i . PROPER <br /> Short( TY TAX#: <br /> LEGAL for new construction: ShoPllat/suhdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Y ' j/a�c-.-- o rte".C tk TENANT NAME(If Commercial): -'C.U3-c <br /> OWNER MAILING ADDRESS: STREET 4 EV W IL" ) ] <br /> CITY Lae-, ��e STATEZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: a r 7 <br /> CONTRACTOR ADDRESS: STREET <br /> CIITY` �(��E�— STATE �,. ZIP s2 2 <br /> CONTRACTOR PHONE: �� 171 V 7 O �SCONTRACTOR EMAIL: Cg �S I l { Lo +. AFT <br /> 15 f l c��� <br /> CONTRACTOR LICENSE#(REQUIRED): ( - 7b <br /> 3 F CITY OF EVERETr BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �- <br /> CONTACT EMAIL: 'S <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T e: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: 'Wommercial ❑Industrial <br /> T pe of Pro ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. i n ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: 7 <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 Tra <br /> Gas Range Ductin 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 /> Number 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 Oficial before being authorized under any circumstance.I am the owner,or t 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 /> City of Everett Official Use Only <br /> PERMIT# 1 <br /> Owner/Authorized Agent Signature Dat� (Revised 10/12/2015) <br />