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PERMIT APPLICATION <br /> BUILDIN( �ECHANICAL / PLUMBING / SIGN ' � 'RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC:�S <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �J Z PROPERTY TAX#: <br /> 0 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> CITY � STATE �/� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTReeT � y�� <br /> CITY � STATE ZIP �I�1 <br /> CONTRACTOR PHONE: �S � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Piease Specify) <br /> CONTACT NAME: ^ CONTACT PHONE: ���s"�� � L- <br /> ���j CONTACT EMAIL: ' �� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 2. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � ��r � ���v,� _A ., vl,��'y�� �� � <br /> GW� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLIC/�ATION 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 Fi�ctures #of List of Fixtures <br /> Fixtures Fixtures Fixture 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 pther: � Clothes Washer Medical Gas <br /> ' Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �� <br /> PRINKLER/SUPPRESSION SYSTEM "'� <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information confained 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 I am aufhorized 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 /> City of Everett Official Use Only <br /> � � PERMI���D � — G�� � <br /> Owner/ orized Agent Signature Date (Revised 10/12/2015) � '� � <br />