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BUILDINC�IIECHANICAL/ PLUMBING / SIGN�RINKLER/ DEMOLITION <br /> - CITY OF EVERETT PERMIT SERVIC � <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 Pl�ase) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � t` =��-;-L,�;�����' PROPERTY TAX#: �Otf� " �� C��'i 4' <br /> LEGAL for new construction: Short PlaUsubdivisio� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'L�� �� � �- . � J � � (�C TENANT NAME (If Commercial): �� � <br /> OWNER MAILING ADDRESS: sTReer � , .S� 1L9� ,'] <br /> a'�+ , <br /> CITY / .. � STATE �� � ZIP f��� <br /> OWNER PHONE: �,�, � (�� OWNER EMAIL: � �• �� <br /> -��j C�" ..� � �%' � -� C-�r►� � t�l�t��,�.s - .Ce. <br /> CONTRACTOR NAME: � �!, � /�l I L`�J�'j, fT--JC�tc^� L� <br /> CONTRACTORADDRESS: srReEr ��"�?�j`S� C;j`f'f/') �r{ /�,i <br /> CITY �li�C��.,�1'1.li�1�1 .� STATE �� ZIP ����� <br /> CONTRACTOR PHONE: ' �� �; - :3tE,'� CONTRACTOR EMAIL: `�'� /yl ;�';�-� C� <br /> d'i t1 i --„ <br /> CONTRACTOR LICENSE#(RECIUIRED): ' � rv --,�� � �j �- ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C!� �2 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �} . _`j f�'1---��-, :�-(f,� <br /> �r t�C'f�f'�`L�f_-%-��G�� CONTACT EMAIL �1 y d y�y7 <br /> �f"'{�I�. ��li �— �/�/CLt � �C)!L <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin � <br /> g g: ��`' � Contract Price of Work:$ - �` �L� <br /> � [�Gas �etric ❑Other <br /> Proposed Use of Building: ,S��k-- Heat Source: <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: ; - <br /> ,:�1/1�� �-t f�,G��i� c<<� c� �' nr 2� �%C�_�-G� �a��;����e t�, �Crt� ���iv�- . <br /> ✓✓�LJ ��/'7�c'_� /i'C�k� /V�c..ci �IC'C;�. ��J�_ L' I��.�'i r��-1�`CSE'i Ct-ft i'�r c�/ �i,-in-� <br /> ���L--r�.f.e. ,�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 Vst of Fixtures #�� List of Fixtures #�f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater � Bathtub Urinal <br /> Gas Piping Boiler / Lavato (Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> / Gas Range Ductin Dishwasher <br /> Clothes Dryer Hookups Other: � Clothes Washer Medical Gas <br /> / Range Hood ter Other: <br /> Exhaust Fan Sink(Service/BarlMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the infwmation contained herein is true aitd conect. Work done pursuant to this permit must compiy with <br /> current federal,state,and bcal law. The grarrting of a permit only authorizes approved work anri ra deviations therefrom.Deviations must first be autirwized in wiiting from the <br /> Building OSicia!before being authorized under any circumstance.l am the owner,or I am authwized by the owner of this property to periorm the work foi whrch application is macie, <br /> and l compty with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereff OHicial Use Only <br /> ,;/' /� `-`� � PERM IT# ,-- <br /> ' �'-'� �' � �I � I ���r <br /> ����_ <br /> , <br /> , <br /> �� ,�z� � <br />