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PERMIT APPLICATION <br /> �UILDING MECHANICAL/ PLUMBING / SIGN /�INKLER/ 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 INFORMATION <br /> PROJECT SITE ADDRESS: � �t�� �c��—��'E?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: � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer ��� � 4�,Q� <br /> CITY -����� STATE �}. ZIP ����� <br /> OWNER PHONE: �� �^�, OWNER EMAIL: '� <br /> CONTRACTOR NAME: • �-�— � v � �� � <br /> CONTRACTOR ADDRESS: sTREEr �'L C�' � �,J�t, {V`-'-- <br /> CITY � � ��. STATE l/�d- ZIP �C7/ � � <br /> �� <br /> CONTRACTOR PHONE: �-{j�� ��r-' �L�;� � CONTRACTOR EMAIL: � U,�� . � , � •,n <br /> ����� �. 2a .C.c,, <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �l�� <br /> PRIMARY CONTACT: ❑ OWNER �I:CONTRACTOR '�OTHER(Please Specify) � J�-'� , " �(�1'r-S � � ;�- -,�:� a, :� <br /> CONTACT NAME: CONTACT PHONE: L�'Z j �t� !—'�r=��c'� <br /> �,� �—,��11�7� CONTACT EMAIL: �'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. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �IUw�f�i� -(�v �', <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 _ Iteration _Repair <br /> #of List of Fixfures ��f Lisf 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 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&Disposai Grease Trap <br /> Gas Range Ducting � Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood � Water Heater Other: <br /> Exhaust Fan I 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 /> euilding Official before being authorized under any circumstance. I am the ow�er,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 Stat�ntractors Law 18'27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � � PERMIT# <br /> �- z 2.�t / " � �� �2 r 0�� <br /> Owner Authorized Agent Signature Date (Revised 9/23/20i6J <br />