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• PERMIT APPLICATIO� <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 Onty Please} PROJECT SITE INFdRMAT10N <br /> PROJECT SITE ADDRESS: � �V � PROPERTY TAX#: pZ,�('�( B� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INF�RMATION <br /> OWNER NAME: p� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRee-r � ,E„ <br /> CITY STATE ZIP <br /> OWNER PHONE: ZS Z,,- � OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: srReeT T� � <br /> CI1Y �J��� STATE ZIP <br /> CONTRACTOR PHONE: �"fL� -- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR THER(Please Specify) �N�ql� <br /> CONTACT NAME: CONTACT PHONE: ,,,, � p <br /> ��� CC�{LUL�� �S� CONTACT EMAIL: �e � �LSY7��-cN- .C'�c�K <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 'lj Contract Price of Work:$ <br /> Proposed Use of Building: S 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 epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> p_ t <br /> Il��� �� �b�,4�� �l'.�-- � _' �►w�,St.�.�5 � �f'r'��- ��F�ST� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> �Z���`�'A�4� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLECATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of Lisf of tures #of Lisi of Fixtures #°f List of ' tures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units t Pump Toilet Backflo reventer(Inside Bldg <br /> Forced Air Systems Unit Heater Bathtub Ur' <br /> Gas Piping Boiler Lavatory(Wash Basin) rinking 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 D Hookups Other: Clothes Was Medical Gas <br /> Range ood Water er Other: <br /> Ex ust Fan Si ervice/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 Official before being authorized under any circumstance.I am the owner,or I am authorized by ihe owner of fhis property to pertorm 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�I DI� �� <br /> � � <br /> Owner i gent Signature ate (Revised 9/23/2016) <br /> �i� 1 <br /> z <br />