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PERMIT APPLICATION <br /> �UILDWG �cCHANICAL/ PLUMBING /SIGN / S�IVafLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATIORI <br /> PROJECT SITE ADDRESS: L`� �/. �I; �,� � ��;� n i� ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � ;� � .S ��. TENANT NAME(If Commercial): �,�f�i �J� � S:�'I r�,, <br /> OWNER MAILING ADDRESS: sTREET ?, � � �v1.��c.��— � � ,) }� ( ��� <br /> CITY � �/�-��'1 � . �/� STATE ZIP <br /> OWNER PHONE: �� ' - ��'; -i"` � � - OWNER EMAIL: _V�_�'.i�_(�IG� � [ ,�;c� .1 : , •t-. • ��t� <br /> CONTRACTOR NAME: r� C C�.f� •�.{ l✓�y�� , ! \�-�/�� � Q�, <br /> CONTRACTORADDRESS: srREer ' � � �j, �.� ✓ -- .r�-I,� �JX,r' ' �M G� <br /> � � �J(� <br /> CITY '-�"�- STATE V�1 l ZIP � '���-' j <br /> CONTRACTOR PHONE: �(Z 4�- i � CONTRACTOR EMAIL: �Mu�,� V!Uian l�� 'a -,�� g� � <br /> CONTRACTOR LICENSE#(REQUIRED):A(,L L � -( 1+. ~' CITY OF EVERETT BUSWESS LICENSE#(REQUIRED) G� � <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR �OTHER(Please Specify) �, J�}- ; u �W h-� <br /> CONTACT NAME: CONTACT PHONE: l� � `' ��L. �Z 3 '� <br /> � '� <br /> �� ��,'Vl�LI � ���I�'I CONTACT EMAIL: � �i; � y� '� <br /> (� n.:�( r�l I .. .ly �.�I �.. b � � �1� <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 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: <br /> i^, r;��i t� ���� ���✓� . <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 Lisf of Fixtures #�f List of Fixiures #of Lisf of Fixtures <br /> Fixiures Fixtures Fixtures Fi�rtures <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 No.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 Official before being authorized under any circumstance.I 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 18.27 RCW and 296.200A WAC. <br /> Cify of Everett Official Use Only <br /> PERMIT# <br /> � ���� z� , ��� � 1�102-�� � <br /> Owner%'At+ A e ature Date (Revised 9/23/2016) <br /> �� � <br />